2022 Prac Exam Questions

Question 1

Acute chest pain due to CAD is caused by what?

Answer 1

Increased myocardial 02 demand and decreased myocardial 02 supply

Question 2

What is the primary goal in chest pain management?

Answer 2

Open the artery and keep it open

Question 3

What are the 3 commonly used medications in acute chest pain and management?

Answer 3

GTN, morphine, and aspirin

Question 4

When giving morphine for acute chest pain, what are three key nursing considerations?

Answer 4

RR under 12, altered level of consciousness, and hypotension

Question 5

Aspirin is what type of drug?

Answer 5

An antiplatelet

Question 6

The role of statins in acute chest pain management is what?

Answer 6

To lower total cholesterol / low-density lipid levels

Question 7

Three medication classes used in the treatment of heart failure are what?

Answer 7

Diuretics, statins and beta blockers

Question 8

Beta blockers do what?

Answer 8

Slow the HR, lower the BP and reduce the force of contraction.

Question 9

Ace inhibitors do what?

Answer 9

Promote vasodilation and diuresis, decreasing the workload of the heart.

Question 10

Diuretics do what?

Answer 10

Increase sodium and water excretion by the kidneys

Question 11

You are looking after a patient who has recently been diagnosed with asthma. You are the practice nurse responsible for providing an education session. Which of the following best describes the cause of their breathlessness?

A. Bronchospasm, increased mucous production and narrowing of airways
B. Coughing, wheezing and apnoea
C. Narrowing of airways, vasodilation and bronchospasm
D. Tachypnoea, decreased mucus production and bronchodilation

Answer 11

A. Bronchospasm, increased mucous production and narrowing of the airways

Question 12

Metastasis is defined as what?

A. The process of benign cells migrating to another region
B. Cancer cells moving from their original location to other sites
C. Growing in or penetrating a body cavity
D. The interruption of growth of malignant cells

Answer 12

B. Cancer cells moving from their original location to other sites

Question 13

A common side effect of chemotherapy includes?

A. Decreased level of consciousness
B. Depression
C. Nausea and vomiting
D. All of the above

Answer 13

C. Nausea and vomiting

Question 14

You are caring for a patient who has right-sided paralysis and aphasia after an embolic stroke that occurred two days ago. These symptoms indicate that?

A. The damage was probably in both hemispheres of the brain
B. The damage was probably in the left side of his cerebrum probably in the frontal area
C. The damage was probably in the right side of the brain
D. He will probably regain function quickly after this type of injury

Answer 14

B. The damage was probably in the left side of his cerebrum probably in the frontal area

Question 15

Prolonged hypertension results in the following permanent change in the vascular system:
A. Development of lipid plaques in large veins
B. Recurrent infection in peripheral arteries
C. Damage to the arterial walls
D. Increased systemic vasodilation

Answer 15

C. Damage to the arterial walls

Question 16

The nurse is concerned that their patient may be developing left sided heart failure. Signs and symptoms of left sided heart failure include:

A. Dyspnoea, orthopnea, and a cough
B. Fatigue, dizziness, and a headache
C. Weakness, palpitations and peripheral oedema
D. Diarrhoea, nausea and vomiting

Answer 16

A. Dyspnea, Orthopnea, and cough

Question 17

What is the underlying pathophysiology of pneumonia?

Answer 17

An infectious microorganism reaches the alveoli, macrophages become overwhelmed and they signal neutrophils, the neutrophils will engulf the alveoli producing a fibrin rich exudate. This exudate fills infected and neighbouring alveoli causing alveoli to stick together and decrease ventilation. The oedema in the alveoli also increase diffusion distance for gases, impairing gas exchange.

Question 18

The nurse undertakes the essential assessments of cultural and spiritual needs, family support, falls risk, smoking history, braden scale, and then records vital signs. This patient has pneumonia.

Identify 3 other priority nursing assessments that are specific to your patient during this acute stage and give your rationale.

Answer 18

Assess the patient’s airway through seeing if they are able to speak full sentences, and while doing so watching for WOB and use of accessory muscles

Posterior chest assessment, assessing for dullness on percussion of the lung fields (indicating lung consolidation)

Posterior chest assessment, assessing for bronchial breath sounds on auscultation (Can indicate consolidation)

Question 19

Based on the following nursing assessments for a patient with pneumonia: Assess patients airway, Posterior chest (percussion), Posterior chest (auscultation)

list 3 priority nursing interventions during the acute phase and provide the rationale for each.

Answer 19

Teach the huff coughing technique to mobilize secretions and expand their lungs to promote ventilation and perfusion.

Encourage fluid intake of 2-3L to thin secretions in the airways and alveoli to aid in the removal of secretions and promote effective gas exchange

Positioning - place the pt in the high fowler’s position as this aids in lung expansion and coughing up of secretions.

Question 20

For a pt that has pneumonia and has an improved condition what would be two assessments the nurse would perform and what would they expect to find that indicates that their interventions have been effective.

Answer 20

Posterior chest assessment, resonance over the lung fields during percussion

Posterior chest assessment, mostly vesicular sounds heard over the lung fields without adventitious sounds during ascultation

Question 21

Patient 2, who is Maori, is admitted with a myocardial infarction

State 5 important points that the cardiac rehabilitation nurse would provide education on prior to discharge.

Answer 21

Keep diet low in sodium and reduce fluids to 2L and under
Reduce alcohol, cholesterol and caffeine intake
Reduce levels of stress
Exercise regularly
Smoking cessation

Question 22

Patient 2, who is Maori, is admitted with a myocardial infarction

The patient tells you that they are upset that the pillow reserved for their head was places on their chair. Discuss the actions you would take to ensure that tikanga is observed.

Answer 22

I would apologise that this occurred and ensure the pillows for this patients head were a blue colour to indicate these were for the head and and inform other staff to please keep these pillows at the top of the bed only to ensure the head is respected. Use white pillows for the body. As per tikanga policy

Question 23

Patient 4, develops pain and swelling in their L) leg. An ultrasound scan confirms a deep vein thrombosis (DVT).

Please outline the aetiology and pathophysiological process that has most likely occurred in the formation of their DVT

Answer 23

DVT’s are caused by 3 main factors described as Virchows triad. These are stasis of blood flow, hyper coagulability, Endothelial injury. You can be more predisposed to these 3 factors if you are older, pregnant, or have had a long period of immobility.

A DVT is a formation of a clot in the deep veins. It is a type of VTE (venous thrombo embolism), blood stasis leads to the formation of a DVT as blood in the peripheral veins will start to clot together due to lack of mobility, hypercoagubility will increase hemostasis of blood in the peripheral veins increasing blood clotting and endothelial damage will causing blood clotting in order to ‘heal’ the damage. This is a result of the platelets in the blood and exacerbated by WBC’s.

Question 24

You are allocated Patient 5 who was admitted with a spinal fracture at the level of the first thoracic vertebrae (T1) the nurse notices a kink in the patients indwelling catheter

Briefly explain the life-threatening complication that could occur from this, and list the clinical manifestations of this complication that is unique to spinal patients.

Answer 24

This can lead to autonomic dysreflexia as the kinked indwelling catheter can cause bladder distension causing a stimulus in the lower body that the body overreacts to. This will cause symptoms such as HTN, a pale, cool and clammy tone to the lower skin, and flushed upper skin, nausea and vomiting, headache, pupil constriction, and bradycardia. This is unique to spinal patients, particularly those with a spinal injury at T6 or above.

Question 25

Name three medication commonly used in management of chest pain and their classes and actions

Answer 25

GTN to relax smooth muscle, and dilate veins and arteries
Morphine (analgesia) to depress the CNS hence reduce pain and promote vasodilation
Aspirin (antiplatelet) to impede clotting

Question 26

Explain the role of statins in acute chest pain management

Answer 26

Statins work to decrease total cholesterol levels which is a risk factor for atherosclerosis. Statins also slow down the progression of disease so they can help delay symptoms such as angina (chest discomfort or breathlessness)

Question 27

List the three key medication classes in the management of heart failure and give examples of these

Answer 27

Ace inhibitors to promote vasodilation and diuresis by decreasing afterload and preload hence decreasing workload of the heart
Beta blockers to slow conduction (HR) and lessen the force of contraction to reduce myocardial workload
Diuretics to provide relief of clinical symptoms of fluid overload.

Question 28

What is CAD?

Answer 28

Coronary artery disease (CAD), also called ischaemic heart disease, happens when the major blood vessels in the heart get narrow and stiff. It can cause myocardial infarction and angina.

Question 29

What is rheumatic fever?

Answer 29

Rheumatic fever starts with a sore throat that is known as ‘strep throat’ – a throat infection caused by a bacteria called Group A Streptococcus.

This is an autoimmune disease. It happens when your immune system makes a mistake and attacks other parts of your body, as well as the strep throat germs.

This can cause inflammation and oedema in the heart, joints (elbows and knees), brain and skin

Question 30

Identify signs and symptoms of a person experiencing an arrythmia

Answer 30

Anxiety.
Fatigue.
Lightheadedness or dizziness.
Sweating.
Fainting (syncope) or near fainting.

Question 31

Monro-Kellie hypothesis states…

Answer 31

that the sum of volumes of brain, CSF, and intracranial blood is constant. An increase in one should cause a decrease in one or both of the remaining two.