‫بسم ا الرحمن الرحيم‬

An-Najah National University

Faculty of Medicine and Health Sciences
Adult health nursing I 7401202
1st semester 2012/2013
Final Exam/ Total marks 50
December, 30, 2012

Name of Student: …………………………..

University Number: …………………………
Mark:…………………………..

Dr. Jamal Qaddumi

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MCQs : Choose the best answer

1. The common feature of the leukemias is:

a) a compensatory polycythemia stimulated by thrombocytopenia.
b) an unregulated accumulation of white cells in the bone marrow, which replace
normal marrow elements.
c) increased blood viscosity, resulting from an overproduction of white cells.
d) reduced plasma volume in response to a reduced production of cellular elements.

2. The nurse should have a high suspicion for myoglobinuria with which type of burn injury?
a) Chemical burn
b) Tar burn
c) Electrical burn
d) Carbon monoxide poisoning

3. All of the following blood studies are consistent with a positive diagnosis of rheumatoid
arthritis (RA) except a(an):
a) positive C-reactive protein (CRP).
b) positive antinuclear antibody (ANA).
c) red blood cell count of _4.0 million/_L.
d) serum complement level (C3) of _130 mg/dL.

4. A technique that assists in the diagnosis of DVT (phlebitis) is:

a) checking for pitting edema.
b) identifying a unilateral weak pulse on the affected extremity.
c) checking for popliteal pain after flexing the patient's knee and dorsiflexing the
foot.
d) listening to lung sounds and assessing for rapid onset of shortness of breath.

5. A new onset MI can be recognized by which of the following ECG changes?

a) Q-waves
b) Smaller R-waves
c) Widened QRS
d) ST segment elevation

6. A positive diagnosis of Hodgkin’s lymphoma depends on:

a) enlarged, firm, and painful lymph nodes.
b) histologic analysis of an enlarged lymph node.
c) progressive anemia.
d) the presence of generalized pruritus.

7. A varicose vein is caused by:

a) phlebothrombosis.
b) an incompetent venous valve.
c) venospasm.

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 d) venous occlusion.

8. One differentiating factor between stable angina and unstable angina is that stable angina:
a) responds predictably well to vasodilators.
b) is not precipitated by activity.
c) has a low correlation to coronary artery disease.
d) is a result of coronary artery spasm.

9. Which of the following clinical manifestations is usually the first symptom of arterial
peripheral vascular disease?
a) Intermittent claudication
b) Thrombophlebitis
c) Pulmonary embolism
d) Cordlike veins

10. Diminished-to-absent breath sounds on the right side, tracheal deviation to the left side, and
asymmetrical chest movement are indicative of which of the following disorders?
a) Tension pneumothorax
b) Pneumonia
c) Pulmonary fibrosis
d) Atelectasis

11. A patient’s assessment data are as follows:

pH 7.10 RR 34 PaCO2 60 HR 128
PaO2 40 BP 180/92 HCO3- 20
This is best described as:
a) uncompensated respiratory acidosis.
b) uncompensated metabolic acidosis.
c) compensated metabolic acidosis.
d) compensated respiratory acidosis.

12. The nurse knows that a patient is developing abdominal compartment syndrome when:
a) the pulmonary inspiratory pressures decrease.
b) the urine output increases.
c) the bladder pressure is over 40 mm Hg.
d) the patient has a widened pulse pressure.

13. Ms. X. is admitted to the intensive care unit after she developed disseminated intravascular
coagulation (DIC) following a vaginal delivery. DIC is known to occur in patients with
retained placental fragments. What is the result of DIC?
a) Hypersensitive response to an antigen, resulting in anaphylaxis

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 b) Depletion of clotting factors and excessive fibrinolysis, resulting in simultaneous
microvascular clotting and hemorrhage
c) Vasodilatation, resulting in hypotension
d) Septic shock, resulting in vasodilation and decreased perfusion

14. Signs and symptoms associated with a flail chest include:

a) tracheal deviation toward the unaffected side.
b) jugular venous distension.
c) paradoxical respiratory movement.
d) respiratory alkalosis.

15. In progressive stage shock, clinical hypotension is present if the systematic blood pressure is:
a) 85 mm Hg.
b) 90 mm Hg.
c) 95 mm Hg.
d) 100 mm Hg.

16. A patient involved in a house fire is brought by ambulance to your emergency department.
He is breathing spontaneously but appears agitated. He does not respond appropriately to
questions. You assume he has inhaled carbon monoxide and is suffering from carbon
monoxide (CO) poisoning. Your first action is to:
a) ask the physician to order a STAT chest x-ray to rule out a pneumothorax.
b) apply a pulse oximeter to one of his unburned fingers.
c) call the local hyperbaric chamber to check on their availability.
d) administer 100% high-flow oxygen via a non-rebreather facemask.

17. Radiation therapy for the treatment of cancer is administered over several weeks to:
a) allow time for the patient to cope with the treatment
b) allow time for the repair of healthy tissue.
c) decrease the incidence of leukopenia and thrombocytopenia.
d) accomplish all of the above.

18. Which of the following signs and symptoms are indicative of disseminated intravascular
coagulopathy (DIC)?
a) Tachypnea and dyspnea
b) Tachycardia and hypotension
c) Elevated serum creatinine and CPK levels
d) Bleeding from invasive-line insertion sites and body orifices

19. The nurse should be alert for a complication of bronchiectasis that results from a combination
of retained secretions and obstruction that leads to the collapse of alveoli. This complication
is known as:

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 a) atelectasis.
b) emphysema.
c) pleurisy.
d) pneumonia.

20. Using the "rule of nines," calculate the percent of injury in an adult who was injured as
follows: the patient sustained partial and full-thickness burns to one-half of his left arm, his
entire left leg, and his perineum.
a) 33%
b) 23.5%
c) 45.5%
d) 16%

21. Realizing that chemotherapy can result in renal damage, the nurse should:
a) encourage fluid intake to dilute the urine.
b) take measures to acidify the urine and thus prevent uric acid crystallization.
c) withhold medication when the blood urea nitrogen level exceeds 20 mg/dL.
d) limit fluids to 1,000 mL daily to prevent accumulation of the drugs’ end products
after cell lysis.

22. The most common cause of bleeding in cancer patients is:

a) anemia.
b) coagulation disorders.
c) hypoxemia.
d) thrombocyotpenia.

23. Nursing measures to prevent thrombophlebitis include:

a) assisting the patient with leg exercises.
b) encouraging early ambulation.
c) avoiding placement of pillows or blanket rolls under the patient’s knees.
d) all of the above.

24. Chest pain described as knifelike on inspiration would most likely be diagnostic of:
a) bacterial pneumonia.
b) bronchogenic carcinoma.
c) lung infarction.
d) pleurisy.

25. Health teaching for viral rhinitis (common cold) includes advising the patient to:
a) blow his or her nose gently to prevent spread of the infection.
b) blow through both nostrils to equalize the pressure.
c) rest, to promote overall comfort.
d) do all of the above.

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26. Patient education for a laryngectomy includes:
a) advising that large amounts of mucus can be coughed up through the stoma.
b) cautioning about preventing water from entering the stoma.
c) telling the patient to expect a diminished sense of taste and smell.
d) doing all of the above.

27. What is the likely depth of injury in a patient with injuries described as moist, red, with some
blister formation, and very painful?
a) Superficial, first-degree burn
b) Partial-thickness, second-degree burn
c) Deep dermal partial-thickness, second-degree burn
d) Full-thickness, third-degree burn

28. A Mantoux skin test is considered not significant if the size of the induration is:

a) 0 to 4 mm.
b) 5 to 6 mm.
c) 7 to 8 mm.
d) 9 mm.

29. A 68-year-old patient is brought to the emergency department after a house fire. The patient
is now in the intensive care burn unit with a heart rate of 140 beats/minute, a urine output of
25 cc/hour, and clear lung sounds. The fluid resuscitation plan:
a) should continue as planned, everything looks good.
b) IV rate should be decreased and more narcotics given.
c) IV rate should be increased and fluid status closely watched.
d) should be switched to packed red blood cells.

30. Acute respiratory failure (ARF) occurs when oxygen tension (PaO2) falls to less than _____
mm Hg
(hypoxemia) and carbon dioxide tension (PaCO2) rises to greater than ______ mm Hg
(hypercapnia).
a) 50 and 50
b) 60 and 60
c) 75 and 75
d) 80 and 80

31. All of the following are manifestations of bacterial pneumonia except:

a) fever.
b) bradycardia.
c) stabbing or pleuritic chest pain.
d) tachypnea.

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32. Two diseases common to the etiology of COPD are:
a) asthma and atelectasis.
b) chronic bronchitis and emphysema.
c) pneumonia and pleurisy.
d) tuberculosis and pleural effusions.

33. Using the Parkland formula for fluid resuscitation and your knowledge of injury calculations
using the "rule of nines," calculate the estimated fluid requirements during the first 8 hours
for a 75-kg patient with the following injuries: full-thickness burns to the anterior chest,
perineum, and entire right leg.
a) 2,775 ml
b) 5,550 ml
c) 8,325 ml
d) 11,100 ml

34. Obstruction of the airway in the patient with asthma is caused by all of the following except:
a) thick mucus.
b) swelling of bronchial membranes.
c) destruction of the alveolar wall.
d) contraction of muscles surrounding the bronchi.

35. Hypertension is repeated blood pressure measurements exceeding:

a) 110/80 mm Hg.
b) 120/80 mm Hg.
c) 130/90 mm Hg.
d) 140/90 mm Hg.

36. The diagnosis of heart failure is usually confirmed by:

a) a chest x-ray.
b) an echocardiogram.
c) an electrocardiogram.
d) ventriculogram.

37. A nurse who suspects the presence of an abdominal aortic aneurysm should look for the
presence of:
a) a pulsatile abdominal mass.
b) low back pain.
c) lower abdominal pain.
d) all of the above.

38. An expected nursing diagnosis for a patient with hypertension is:

a) heart failure.
b) knowledge deficit.
c) myocardial infarction.

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 d) renal insufficiency.

39. One of the most significant concerns for medical and nursing management of hypertension
is:
a) complications from medications.
b) insufficient information.
c) noncompliance with recommended therapy.
d) uncontrolled dietary management.

40. Myeloid and lymphoid stem cells produce specific types of blood cells. The nurse knows,
when evaluating blood tests, that myeloid stem cells differentiate into all of the following
types of blood cells except:
a) erythrocytes.
b) leukocytes.
c) lymphocytes.
d) platelets.

41. The nurse begins to design a nutritional packet of information for a patient diagnosed with
iron deficiency anemia. The nurse would recommend an increased intake of:
a) fresh citrus fruits.
b) milk and cheese.
c) organ meats.
d) whole-grain breads.

42. A patient with chronic renal failure is being examined by the nurse practitioner for anemia.
The nurse knows to review the laboratory data for a decreased hemoglobin level, red blood
cell count, and:
a) decreased level of erythropoietin.
b) decreased total iron-binding capacity.
c) increased mean corpuscular volume.
d) increased reticulocyte count.

43. A nurse should know that a diagnosis of hemolytic anemia is associated with all of the
following except:
a) abnormality in the circulation of plasma.
b) decrease in the reticulocyte count.
c) defect in the erythrocyte.
d) elevated indirect bilirubin.

44. Sickle-shaped erythrocytes cause:

a) cellular blockage in small vessels.
b) decreased organ perfusion.
c) tissue ischemia and infarction.
d) all of the above.

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45. Multiple myeloma:
a) can be diagnosed by roentgenograms that show bone lesion destruction.
b) is a malignant disease of plasma cells that affects bone and soft tissue.
c) is suspected in any person who evidences albuminuria.
d) is associated with all of the above.

46. The classic presenting symptom of multiple myeloma is:

a) debilitating fatigue.
b) bone pain in the back of the ribs.
c) gradual muscle paralysis.
d) severe thrombocytopenia.

47. Bleeding and petechiae do not usually occur with thrombocytopenia until the platelet count
falls below 50,000/ mm3. The normal value for blood platelets is:
a) 50,000 to 100,000/mm3.
b) 100,000 to 150,000/mm3.
c) between 150,000 and 350,000/mm3.
d) greater than 350,000/mm3.

48. Hemophilia is a hereditary bleeding disorder that:

a) has a higher incidence among males.
b) is associated with joint bleeding, swelling, and damage.
c) is related to a genetic deficiency of a specific blood-clotting factor.
d) is associated with all of the above.

49. A characteristic cutaneous lesion, called the “butterfly rash,” appears across the bridge of the
nose in 50% of patients with:
a) gout.
b) rheumatoid arthritis.
c) systemic sclerosis.
d) systemic lupus erythematosus.

50. write a (Benign) or b (Malignant) in the space

a) B__ Cells bear little resemblance to the normal cells of the tissue from which they arose
b) A__ Rate of growth is usually slow
c) A__ Tumor tissue is encapsulated
d) B__ Tumor spreads by way of blood and lymph channels to other areas of the body
e) B__ Growth tends to recur when removed

Adult Health Nursing I 7401202. 1st semester 2012/2013

Final Exam/ December, 30, 2012
Name of Student: ……………………University Number: …………………………
Answers sheet: MCQ

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1. 21. 41.
2. 22. 42.
3. 23. 43.
4. 24. 44.
5. 25. 45.
6. 26. 46.
7. 27. 47.
8. 28. 48.
9. 29 49.
10. 30. 50.
11. 31.
12. 32.
13. 33.
14. 34.
15. 35.
16. 36.
17. 37.
18. 38.
19. 39.
20. 40.

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