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2025 - 2026 NURS 618 ADVANCED
PATHOPHYSIOLOGY EXAM 1|REAL EXAM
QUESTIONS AND ANSWERS|A+GRADE
The nurse is completing a preoperative assessment of a client who is scheduled for a laparoscopic cholecystectomy under general anesthesia. Which finding warrants notification of the healthcare provider prior to proceeding with the scheduled procedure? a. Light yellow coloring of the client's skin and eyes b. The client's temperature is 99.8F, pulse is 99 beats/min and respiration rate 16 breaths/ min c. The client is slightly anxious about the surgical procedure d. The client's BP reading is 185/95 mmHg e. The IV insertion site is red, swollen, and leaking IV fluid D The new graduate nurse working in the operating room (OR) drops a sterile package of supplies on the floor in the OR suite. The package is covered with an impervious wrapper. Which action should the nurse implement? a. Open the contents to the sterile field if the package integrity is intact b. Ask the new graduate nurse to work in the OR and not to come back before she learns handling sterile package of supplies c. Return the package for re-sterilization d. Discard the package and its contents e. Document one the OR record that a sterile package was dropped on the floor A
A female client has refused to remove her wedding ring on the morning of surgery. The nurse should take which action? A. Have the client's mental status assessed in preparation for surgery B. Tape the ring securely to the finger and document the encounter C. Ask the client's husband to convince her to remove the ring D. Report to surgeon so that the surgery can be rescheduled E. Note the presence of the ring in the nurses' notes section of the chart. B The nurse is caring for a postoperative client with an intermittent compression device on a surgical unit. Which of the following actions should the nurse take to evaluate the effectiveness of the intermittent compression device? A. Assess the amount of drainage from the surgical incision B. Palpate peripheral pulses for volume, strength, and rhythm C. Assess the client's ability to perform deep breathing and coughing effectively with appropriate splinting of the surgical site D. Assess signs and symptoms of thrombophlebitis including redness and swelling on both lower extremities E. Assess the client's ability to use the incentive spirometer effectively D
C. By administering sedatives and cough suppressants D. By encouraging vigorous abdominal exercises E. By encouraging deep breathing and coughing exercises with proper splinting of the surgical site A,B,E A client on the postoperative unit reports having severe difficulty in breathing. The nurse discovers that the client received frequent large doses of Morphine Sulfate. What should the nurse include in the client's plan of care? A. Administer a non-steroidal inflammatory drug B. Administering Baclofen, a muscle relaxant C. Administering Naloxone D. Call the respiratory therapist to draw blood for arterial blood gas (ABGs) Loosening the dressings C A student nurse is asking about the maximum daily dose of acetaminophen from all sources and the antidote of acetaminophen. What is the best response? A. The maxim daily dose is 4 grams and the antidote is acetylcysteine (Mucomyst) B. The maximum dose is 2 grams and the antidote is vitamin K C. The maximum dose is 4 grams and the antidote is Naloxone (Narcan) D. The maximum dose is 3 grams and the antidote is protamine sulfate A
A client has a great deal of pain when coughing and deep breathing after abdominal surgery despite having the maximum dose of Methadone (Dolophine) pain medication. What action by the nurse is best? A. Tell the client that pain is expect, and he can take more Methadone B. Demonstrate to the client how to splint the incision by using a pillow to support the abdomen C. Call the provider to request more opioid analgesics D. Have the client take shallow breaths and then cough vigorously B The nurse is monitoring the vital signs of a client after a major abdominal surgery. The nurse noticed a marked drop in the client's blood pressure from 148/87 to 87/67 and a marked increase in the client's heart rate from 84 beats/min to 127 beats/min. Which action should the nurse take first? A. Encourage the client to breathe deeply B. Check the abdominal surgical dressing for bleeding C. Encourage the client to use the incentive spirometer D. Review the client's baseline blood pressure trends B The nurse is caring for a client with chronic pain who is maintained on Morphine Sulfate patch. The nurse notices the client to be short of breath and is difficult to arouse. When performing the head to toe assessment the nurse discovers five narcotic analgesic patches on the client's body. Which intervention should the nurse implement first?
A client post abdominal surgery coughs and states "the insides of my abdomen came out". What should the nurse's first action? A. Check the client's vital signs B. Visualize (look at) the client's abdominal incision C. Call the healthcare provider (HCP) immediately D. Soak the wound with a normal saline gauze or a wet towel B A client with advanced metastatic bone cancer complains of pain 9/10. What should the nurse do first? a. Record in the chart the client has moderate pain b. Give the client a narcotic and a non-opioid analgesic at the same time to manage the pain c. Wait until the pain becomes 10/10 and then administer a narcotic analgesic d. Assess for drug addiction. B What atypical symptoms would a woman who is having a myocardial infarction experience?
A. Pain that spreads across the chest and back and/ or radiates down the arm B. Sudden, intermittent, stabbing chest pain C. Indigestion, feelings of chronic fatigue, and a choking sensation D. Moderate ache in the chest that is worse on inspiration C Which of the following should the nurse teach to a client with venous leg ulcer? A. Eat diet high in proteins and vitamin A and C to promote tissue healing B. Monitor for irregular shape ulcer and severe edema as well as for symptoms of worsening skin integrity C. Avoid immobility as it may worsen the condition by decreasing tissue perfusion D. Elevate the legs ( for 30 minutes 3 or 4 times per day to decrease swelling & improve blood flow in the vein) to promote venous return E. Apply intermittent cold compresses 4 times daily A.B.C.D The nurse is developing a discharge-teaching plan for the client diagnosed with congestive heart failure. Which interventions should be included in the plan of care? A. Notify healthcare provider of a weight gain of more than 2 lbs/ day
C. Troponin D. Creatine kinase (Ck-mb) E. Beta-type natriuretic peptide (BNP) E The nurse is teaching the Dietary Approaches to Stop Hypertension (DASH) diet to a client diagnosed with essential hypertension. Which statement indicates that the client understands the teaching concerning the DASH diet? A. "I should decrease my grain intake to no more than twice a week" B. "I should drink no more than 2 glasses of whole milk a day" C. "I should eat meat that has a lot of white streaks in it and increase whole milk and dairy" D. "I should eat low salt diet, increase fruits, vegetables, non-fat or low-fat yogurt and dairy" D A client is complaining of headache, dizziness, and blurred vision. The client reports insomnia due to a very stressful life. The nurse checked the vital signs and the client was prescribed a stat dose of Sodium Nitroprusside ( Nipride) IV. After administering the medication, which intervention is most important for the nurse to implement? A. Request a prescription for pain medication
B. Monitor the client's blood pressure very closely for hypotension C. Measure the client's urine output hourly to assess for renal perfusion D. Monitor the client's abdominal girth to monitor to overweight, obesity or metabolic syndrome B Which of the following are risk factors for coronary artery disease? A. Diabetes mellitus B. Family history of coronary artery disease C. Client's inability to afford the prescribed "statin" (indicated for hyperlipidemia) and metoprolol (indicated for hypertension) D. Marked increase in abdominal girth E. Not receiving early childhood immunizations A,B,C,D Where is the point of maximal impulse (PMI) located? A. Left 5th intercostal space (ICS) just medial to midclavicular line B. Left 4th intercostal space (ICS) midaxillary line C. Right 5th intercostal space (ICS) midclavicular line D. Right 4th intercostal space (ICS) midclavicular line
The nurse is caring for a client with chronic venous insufficiency who complains of edema, redness and deep pain in the left calf and has developed a deep vein thrombosis (thrombophlebitis). Which nursing interventions should be implemented? A. Increase frequency of ambulation and encourage prolonged sitting with crossing legs B. Instruct the client to stay in bed and not ambulate to avoid dislodging the clot. C. Place sequential compression devices on both legs to prevent DVT D. Encourage reclining while sitting to keep the legs at high level in order to facilitate blood flow and venous return E. Administer Heparin IV and monitor the client's partial thromboplastin time (PTT) at baseline (right before standing the heparin infusion, and then Q6 hours until two consecutive PTT levels are obtained) B,D,E A client admitted to the hospital with chest pain and a history of type 2 diabetes mellitus is scheduled for cardiac catheterization. Which medication would need to be withheld for 24 hours before the procedure and for 48 hours after the procedure? A. Glipizide B. Regular insulin C. Repaglinide
D. Metformin E. NPH insulin D We have an expert-written solution to this problem! The nurse is caring for a male client with heart failure maintained on Digoxin and Furosemide. The client reported he missed his prescribed morning Furosemide and Digoxin doses today. Lab results reveal a serum beta-type natriuretic peptide (BNP) of 1500 pg/mL; Digoxin serum level 1.3 ng/mL; potassium 5.7 mEq/L. Physical exam reveals increased abdominal girth and basilar crackles. The client reports SOB productive cough and lower extremity edema. Which nursing intervention should the nurse do first? A. Teach the client about his medication regimen and compliance with the treatment as prescribed B. Administer Digoxin C. Administer Furosemide D. Measure the client's abdominal girth C The nurse is caring for a client who just came back to the unit post femoral cardiac catheterization on heparin drip. Which nursing interventions should the nurse take?
The client shows ventricular tachycardia on the telemetry at the nurse's station. After activating a STAT code, which action should the telemetry nurse implement first? A. Call the respiratory therapist to draw blood for ABGs that will dictate oxygen therapy B. Administer Amiodarone (Cordarone) IVP C. Bring the crash cart to the client's room and turn the synchronized button on the defibrillation "on" D. Start cardiopulmonary resuscitation if a defibrillator is not available, and immediately defibrillate the client as soon as a defibrillator becomes accessible. E. Insert a peripheral IV and if the client is hard to stick, call the provider to insert a central line. D Which intervention should the nurse implement when defibrillating a client who is in ventricular fibrillation? A. Do not remove the oxygen source during defibrillation B. Make sure the "Synchronize" button on the machine is turned on C. Defibrillate the client at 20,50, and then 75, 100 joules D. Place petroleum jelly on the defibrillator pads E. Shout "all clear" prior to defibrillating the client E
The client is exhibiting ventricular tachycardia. Which intervention should the nurse implement first? A. Administer Atropine sulfate and educate the client about its potential side effects B. Administer Amiodarone, an antidysrhythmic, IVP C. Start basic cardiopulmonary resuscitation D. Assess the client's pulse E. Prepare to defibrillate the client D The client who is 1 day postoperative coronary artery bypass surgery is exhibiting sinus tachycardia (HR= 104 beats/min). Which intervention should the nurse implement? A. Administer Adenosine IV push start to convert the dysrhythmia to normal sinus rhythm B. Notify the client's cardiac surgeon because this is life threatening cardiac dysrhythmia C. Determine of the client is having any pain to identify the cause of the dysrhythmia D. Assess the apical heart rate for 1 full minute and administer Atropine Sulfate. E. Prepare the client for synchronized cardioversion.
D
The client is experiencing frequent multifocal premature ventricular contractions. Which antidysrhythmic medication would the nurse expect the healthcare provider to order for this client? a. Digoxin b. Adenosine c. Amiodarone d. Epinephrine e. Atropine C Which of the following requires the nurse notify the healthcare provider (HCP)? A. The client receiving station who has a cholesterol level of 195 mg/dL B. The client receiving furosemide who has a potassium level of 3.5 mEq/L C. The client receiving IVP Digoxin who has a Digoxin level of 2.8 ng/dL D. The client receiving Coumadin (Warfarin) who has an INR of 1. C
The nurse is caring for clients on a vascular disorder unit. Which laboratory data warrant immediate intervention by the nurse? A. The hemoglobin 11.4 for a client diagnosed with Raynaud's phenomenon B. The PTT of 128 seconds for a client diagnosed with deep vein thrombosis (DVT) C. The white blood cell (WBC) count of 10,500 for a client with a stasis venous ulcer D. The triglyceride level of 212 mmol/L in client diagnosed with hypertension (HTN) B Provider's prescription Lidocaine 4 mg/min IV Supply/ stock 3g in 250 mL. Calculate the flow rate in mL/hr. a. 20 b. 32 c. 12 d. 62 A Order D5W 250 mL with heparin 22000 units IV at 9 units/kg/hr. Client's weight is 176 lbs. At what rate would you program the IV pump? (in mL/hr)
