Nursing Exam Prep

NCLEX-RN: Health Alterations practice questions questions 51-75

267 questions, page 3 of 11. Try each one first, then open the answer.

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51Question

An older adult with early-stage dementia who retains decision-making capacity refuses a scheduled diagnostic colonoscopy. Which actions should the nurse take?

Select all that apply.

  1. Postpone the procedure until the patient is more compliant.
  2. Document the patient's specific reasons for refusal.
  3. Discuss the potential risks of not having the procedure.
  4. Notify the healthcare provider of the patient's decision.
  5. Obtain consent from the power of attorney instead.
Show the answers and explanation

Answers: B, C and D.

  • B – Document the patient's specific reasons for refusal.
  • C – Discuss the potential risks of not having the procedure.
  • D – Notify the healthcare provider of the patient's decision.

Patients who retain decision-making capacity have the ethical and legal right to refuse medical procedures, regardless of a dementia diagnosis. The nurse must advocate for client autonomy by ensuring informed refusal, documenting the patient's stated reasons, and notifying the healthcare provider. Surrogate decision-makers cannot override a competent patient's choices.

Why the others are wrong

  • A – Delaying the procedure to gain compliance violates the patient's autonomous right to permanently refuse the intervention.
  • E – A durable power of attorney only makes decisions when the patient is assessed to lack decision-making capacity.

Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.

52Question

A nurse is planning care for a geriatric patient with severe dysphagia following an acute ischemic stroke. Which activities can the nurse safely delegate to unlicensed assistive personnel (UAP)?

Select all that apply.

  1. Positioning the patient upright at 90 degrees
  2. Performing the bedside swallow screen
  3. Adjusting liquid thickness based on tolerance
  4. Weighing the patient daily before breakfast
  5. Reporting any coughing or choking during meals
Show the answers and explanation

Answers: A, D and E.

  • A – Positioning the patient upright at 90 degrees
  • D – Weighing the patient daily before breakfast
  • E – Reporting any coughing or choking during meals

Weighing the patient, reporting signs of aspiration like coughing, and positioning the patient upright are standard, non-invasive tasks that do not require clinical judgment. These fall within the scope of practice for unlicensed assistive personnel under the nurse's supervision.

Why the others are wrong

  • B – Performing a swallow screen requires specialized clinical assessment and judgment, which cannot be delegated to unlicensed personnel.
  • C – Adjusting liquid consistency requires clinical evaluation of swallowing ability and must be determined by a licensed professional.

Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.

53Question

A competent older adult patient refuses mechanical ventilation, but the patient's adult child, who holds durable power of attorney (DPOA), demands the procedure be performed. Which actions should the nurse take?

Select all that apply.

  1. Honor the patient's decision to refuse the treatment.
  2. Obtain consent from the DPOA to initiate the procedure.
  3. Assess the patient's current decision-making capacity.
  4. Explain that the DPOA only activates if capacity is lost.
  5. Request an ethics consult to override the patient.
Show the answers and explanation

Answers: A, C and D.

  • A – Honor the patient's decision to refuse the treatment.
  • C – Assess the patient's current decision-making capacity.
  • D – Explain that the DPOA only activates if capacity is lost.

A competent patient retains the absolute right to make their own healthcare decisions, which supersedes any surrogate decision-maker. The nurse must advocate for patient autonomy by honoring the refusal, verifying the patient's decision-making capacity, and educating the family member that a durable power of attorney only takes effect when the patient lacks capacity.

Why the others are wrong

  • B – Obtaining consent from the DPOA to perform an unwanted procedure on a competent patient violates patient autonomy and constitutes battery.
  • E – An ethics committee cannot be used to override the autonomous, competent decisions of a patient.

Written for the Medical Exam YouTube channel and answered blind by a second AI model before publication.

54Question

The correct ordering of the vertebral column is

  1. Sacrum and coccyx, cervical, thoracic, lumbar
  2. Lumbar, cervical, thoracic, sacrum and coccyx
  3. Cervical, thoracic, lumbar, sacrum and coccyx
  4. Thoracic, lumbar, cervical, sacrum and coccyx
Show the answer and explanation

Answer: C. Cervical, thoracic, lumbar, sacrum and coccyx

Topic: Vertebral Column Anatomy

The vertebral column is ordered from superior to inferior starting with the cervical vertebrae in the neck, followed by the thoracic, lumbar, sacrum, and coccyx at the base.

Why the others are wrong

  • A – This incorrectly lists the sacrum and coccyx at the top of the column.
  • B – This incorrectly places the lumbar spine superior to the cervical and thoracic regions.
  • D – This incorrectly positions the thoracic spine superior to the cervical spine.

Remember: Can Toddlers Like Sweet Candy? (Cervical, Thoracic, Lumbar, Sacrum, Coccyx).

Question adapted from Health Alterations, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

55Question

While providing discharge teaching to a patient prescribed Ropinirole (Requip), you make it priority to teach the patient about what side effect?

  1. Coughing
  2. Drowsiness
  3. Dark sweat or saliva
  4. Dry mouth
Show the answer and explanation

Answer: B. Drowsiness

Topic: Dopamine Agonist Side Effects

Ropinirole commonly causes somnolence, which can impair safety and daily functioning; therefore, educating patients about drowsiness is essential for preventing falls and accidents after discharge.

Why the others are wrong

  • A – Coughing is not associated with ropinirole.
  • C – Dark sweat or saliva is not a known side effect.
  • D – Dry mouth is less frequent and not safety‑critical.

Remember: Ropinirole = Restless legs, Restful sleep (drowsiness).

Question adapted from Health Alterations, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

56Question

Painful or difficult urination is defined as

  1. Enuresis
  2. Oliguria
  3. Pyuria
  4. Dysuria
Show the answer and explanation

Answer: D. Dysuria

Topic: Urinary Symptoms

Dysuria specifically describes pain, burning, or discomfort during urination, which matches the definition of painful or difficult urination. It is a common symptom of urinary tract infection, prostatitis, or urethral irritation and is distinct from terms describing urine volume or presence of infection.

Why the others are wrong

  • A – Enuresis is involuntary or nighttime urination, not pain during voiding.
  • B – Oliguria describes reduced urine volume, unrelated to pain or difficulty when voiding.
  • C – Pyuria means white blood cells in urine, indicating infection, not painful urination.

Remember: Dysuria = 'dys' (bad) urination pain.

Question adapted from Health Alterations, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

57Question

A nurse has been assigned to triage patients arriving to the emergency department. Based upon prioritization principles. which of the following should be seen first?

  1. A 50-year-old complaining of abdominal pain, nausea, and diarrhea for the past two days.
  2. A 20-year-old with a superficial head wound.
  3. A 35-year-old with a complete fracture of the upper arm
  4. A 10-year-old with a high fever and difficulty breathing.
Show the answer and explanation

Answer: D. A 10-year-old with a high fever and difficulty breathing.

Topic: Emergency Department Triage Prioritization

Using the ABC (Airway, Breathing, Circulation) prioritization framework, the pediatric patient with difficulty breathing represents a potential respiratory emergency and must be evaluated immediately to prevent respiratory arrest.

Why the others are wrong

  • A – Gastrointestinal symptoms lasting two days are non-emergent and do not compromise immediate airway or circulation.
  • B – A superficial head wound is minor, stable, and can safely wait for evaluation.
  • C – A closed limb fracture is painful but hemodynamically stable and not immediately life-threatening.

Remember: Always prioritize ABCs: Airway and Breathing always come first.

Question adapted from Health Alterations, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

58Question

This term refers to actions within the body where one’s own immune system accidentally initiates a response against the body’s own healthy cells, tissues, or organs.

  1. Metastasis
  2. Carcinogen
  3. Benign
  4. Autoimmune Reactions
Show the answer and explanation

Answer: D. Autoimmune Reactions

Topic: Autoimmune Disorders

Autoimmune reactions occur when the immune system mistakenly attacks the body's own healthy cells, tissues, or organs, leading to conditions such as lupus, rheumatoid arthritis, and type 1 diabetes.

Why the others are wrong

  • A – Metastasis is the spread of malignant tumors, not an immune phenomenon.
  • B – Carcinogen refers to an agent that causes cancer, not an immune response.
  • C – Benign describes non‑cancerous growths, unrelated to immune system activity.

Remember: Autoimmune = body attacks itself.

Question adapted from Health Alterations, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

59Question

One defining characteristic of Crohn’s Disease is:

  1. Inflammation affects 2 layers, the mucosa and submucosa
  2. A cobblestone appearance to the bowel
  3. Inflammation confined to the rectum
  4. Uniform spread of ulcerations
Show the answer and explanation

Answer: B. A cobblestone appearance to the bowel

Topic: Crohn's Disease Characteristics

Crohn's disease is characterized by transmural inflammation and skip lesions, which leave patches of normal tissue alongside diseased tissue, creating a classic "cobblestone" appearance on endoscopy.

Why the others are wrong

  • A – Crohn's is transmural, affecting all bowel wall layers, not just mucosa and submucosa.
  • C – Ulcerative colitis typically begins in the rectum; Crohn's can affect any GI segment.
  • D – This describes ulcerative colitis, which features continuous, uniform inflammation.

Remember: Crohn's skips and cobblestones; UC is continuous and superficial.

Question adapted from Health Alterations, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

60Question

What is a potential sign of an embolism postoperatively?

  1. Dyspnea, pain, and hemoptysis
  2. Hypertension and nausea
  3. Bradycardia
  4. Decreased respiratory rate and decrease pulse oximetry
Show the answer and explanation

Answer: A. Dyspnea, pain, and hemoptysis

Topic: Pulmonary Embolism Signs

Dyspnea, pleuritic chest pain, and hemoptysis indicate a pulmonary embolism, reflecting airway obstruction and infarction of lung tissue; these are the hallmark postoperative signs clinicians monitor for early detection.

Why the others are wrong

  • B – Hypertension and nausea are not typical embolism manifestations; they suggest pain or anxiety.
  • C – Bradycardia is more associated with vagal response or medication effects, not embolic events.
  • D – Decreased respiratory rate and low pulse oximetry are nonspecific and often reflect hypoventilation, not embolism.

Remember: PE: shortness, sharp chest pain, coughing blood.

Question adapted from Health Alterations, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

61Question

What role does the employer/nurse leader play in the delegation process?

  1. Limiting the communication between licensed nurses and delegatees.
  2. Ensuring licensed nurses are not burdened with overseeing delegated tasks.
  3. Restricting the scope of what can be delegated to delegatees.
  4. Identifying a nurse leader responsible for oversight of delegated responsibilities.
Show the answer and explanation

Answer: D. Identifying a nurse leader responsible for oversight of delegated responsibilities.

Topic: Nurse Leader Delegation Role

According to national delegation guidelines, employers and nurse leaders are responsible for establishing organizational structures, which includes identifying a specific nurse leader to oversee the delegation process and ensure safe, competent practice.

Why the others are wrong

  • A – Employers must facilitate, not limit, open communication between nurses and delegatees.
  • B – Licensed nurses always retain accountability and must supervise any delegated tasks.
  • C – Scope of practice is determined by state boards of nursing, not the employer.

Remember: Leaders designate oversight; nurses delegate and supervise.

Question adapted from Health Alterations, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

62Question

The client with acute renal failure has a potassium level of 6.0 meq/L. The nurse would plan for which priority action?

  1. Allow an additional 500 mL of fluid intake to dilute the electrolyte concentration
  2. Encourage increased vegetables in the diet
  3. Check the sodium level
  4. Place the client on a cardiac monitor
Show the answer and explanation

Answer: D. Place the client on a cardiac monitor

Topic: Acute Renal Failure

Hyperkalemia (K⁺ 6.0 mEq/L) can precipitate life‑threatening arrhythmias; continuous cardiac monitoring allows early detection of conduction changes and timely intervention, making it the priority nursing action.

Why the others are wrong

  • A – Additional fluid may overload a failing kidney and delay potassium removal.
  • B – Vegetables are high in potassium and could worsen hyperkalemia.
  • C – Sodium level does not address immediate risk of hyperkalemia.

Remember: HyperK = monitor heart first.

Question adapted from Health Alterations, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

63Question

When considering delegating a nursing responsibility, the licensed nurse must consider which of the following:

  1. The delegatee's preference and willingness to take on the responsibility.
  2. The nurse's personal judgment without considering any guidelines.
  3. The availability of other staff members in the facility.
  4. The stability and predictability of the client’s condition.
Show the answer and explanation

Answer: D. The stability and predictability of the client’s condition.

Topic: Principles of Nursing Delegation

Safe delegation requires the nurse to assess the client's clinical status. Unstable or unpredictable patient conditions require complex nursing judgment and cannot be delegated to unlicensed assistive personnel, ensuring patient safety is maintained.

Why the others are wrong

  • A – Delegatee preference is secondary to competence, scope of practice, and client safety needs.
  • B – Delegation must follow established legal guidelines, state practice acts, and organizational policies.
  • C – Staff availability does not dictate the clinical safety or appropriateness of delegating a task.

Remember: Only delegate when the patient is stable and predictable.

Question adapted from Health Alterations, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

64Question

The nurse reviews the client’s record and notes that the physician has documented that the client has a renal disorder. On review of the laboratory results, the nurse most likely would expect to note which of the following?

  1. Elevated creatinine level
  2. Decreased hemoglobin level
  3. Decreased white blood cell count
  4. Decreased red blood cell count
Show the answer and explanation

Answer: A. Elevated creatinine level

Topic: Renal Function Laboratory Values

Because kidney dysfunction reduces glomerular filtration, creatinine, a metabolic waste normally excreted in urine, accumulates in the blood, producing a commonly elevated serum creatinine level.

Why the others are wrong

  • B – Decreased hemoglobin level is more typical of anemia, not a direct marker of renal function.
  • C – Decreased white blood cell count is unrelated to kidney function, indicating marrow or infection problems.
  • D – Decreased red blood cell count can result from anemia, but isn’t the primary renal indicator.

Remember: Kidney trouble = creatinine climbs.

Question adapted from Health Alterations, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

65Question

A client presents to the clinic with a persistent cough, night sweats, and unexplained weight loss. After diagnostic testing, the client is diagnosed with tuberculosis (TB). The nurse understands that which of the following diagnostic tests can confirm the diagnosis of active TB?

  1. Tuberculin Skin Test (Mantoux Test)
  2. Sputum Culture
  3. Chest X-ray
  4. Interferon-Gamma Release Assays (IGRA)
Show the answer and explanation

Answer: B. Sputum Culture

Topic: Tuberculosis Diagnostic Testing

A sputum culture is the gold standard for confirming active tuberculosis because it isolates and identifies *Mycobacterium tuberculosis*. Other diagnostic modalities can suggest infection or show exposure, but only a culture provides definitive confirmation of active disease.

Why the others are wrong

  • A – Indicates exposure or latent infection but cannot distinguish active from latent disease.
  • C – Identifies lung abnormalities suggestive of TB but cannot provide definitive microbiological confirmation.
  • D – Measures immune reactivity to TB but cannot differentiate active from latent infection.

Remember: Sputum culture is the gold standard to confirm active TB.

Question adapted from Health Alterations, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

66Question

A contracture is the result of joint immobility and can result in as little as:

  1. 2 hours
  2. 2 days
  3. 2 weeks
  4. 2 minutes
Show the answer and explanation

Answer: B. 2 days

Topic: Immobility and Contractures

Joint immobility causes rapid muscle fiber shortening and connective tissue changes, allowing contractures to begin forming in as little as 2 days. Early range-of-motion exercises are essential to prevent this permanent joint deformity.

Why the others are wrong

  • A – Two hours of immobility causes temporary stiffness, not structural contractures.
  • C – Contractures begin forming much earlier than two weeks of joint immobility.
  • D – Two minutes of immobility is far too brief to cause contractures.

Remember: Two days of immobility can lock a joint.

Question adapted from Health Alterations, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

67Question

A nurse is caring for a client diagnosed with tuberculosis (TB) who is receiving directly observed therapy (DOT). The nurse understands the importance of DOT for medication adherence and preventing the development of drug resistance. Which of the following statements by the nurse accurately explains the rationale for DOT?

  1. "DOT helps prevent treatment failure and control the spread of drug-resistant TB."
  2. "DOT ensures clients receive adequate hydration during treatment."
  3. "DOT ensures that clients with TB take their medications only when they have symptoms."
  4. "DOT reduces the risk of TB transmission to healthcare workers."
Show the answer and explanation

Answer: A. "DOT helps prevent treatment failure and control the spread of drug-resistant TB."

Topic: Tuberculosis Treatment Adherence

Directly observed therapy guarantees that each dose is taken under supervision, maintaining therapeutic drug levels, preventing missed doses, and thereby reducing the chance of treatment failure and the emergence of drug‑resistant Mycobacterium tuberculosis.

Why the others are wrong

  • B – Hydration is important but not the purpose of DOT.
  • C – DOT is for daily supervised dosing, not only when symptoms appear.
  • D – DOT does not primarily protect healthcare workers; infection control measures do.

Remember: Supervised doses stop missed pills, stop resistant TB.

Question adapted from Health Alterations, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

68Question

What is the primary complication associated with malignant hyperthermia during general anesthesia?

  1. Respiratory depression
  2. Increased calcium levels in muscles
  3. Allergic reactions
  4. Hypotension
Show the answer and explanation

Answer: B. Increased calcium levels in muscles

Topic: Malignant Hyperthermia Crisis

Malignant hyperthermia is an inherited pharmacogenetic crisis where triggering anesthetics induce massive, unregulated calcium release within skeletal muscle cells. This excessive intracellular calcium drives sustained muscle rigidity, hypermetabolism, severe hyperthermia, and potentially fatal rhabdomyolysis.

Why the others are wrong

  • A – Hypermetabolism increases carbon dioxide production rather than causing primary respiratory depression.
  • C – Malignant hyperthermia is an inherited metabolic receptor disorder, not an immune-mediated allergic reaction.
  • D – Hypotension can occur late as cardiovascular collapse, but it is not the initiating mechanism.

Remember: Malignant hyperthermia floods muscles with calcium, triggering a hypermetabolic firestorm.

Question adapted from Health Alterations, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

69Question

Which of the following laboratory findings is NOT consistent with acute kidney injury (AKI)?

  1. Decreased creatinine
  2. Hyperkalemia
  3. Decreased urine output
  4. Elevated blood urea nitrogen (BUN)
Show the answer and explanation

Answer: A. Decreased creatinine

Topic: Acute Kidney Injury Lab Values

In AKI the glomerular filtration rate falls, causing accumulation of nitrogenous waste; thus BUN and creatinine rise, urine output often drops, and potassium accumulates, leading to hyperkalemia. Decreased creatinine would be inconsistent.

Why the others are wrong

  • B – Hyperkalemia results from impaired renal potassium excretion in AKI.
  • C – Decreased urine output indicates oliguria, common in early AKI.
  • D – Elevated BUN reflects reduced filtration, a hallmark of AKI.

Remember: AKI = BUN up, creatinine up, pee down, K up.

Question adapted from Health Alterations, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

70Question

Which of the following is considered a modifiable risk factor that should be assessed during a comprehensive cardiovascular assessment?

  1. Elevated jugular venous distention
  2. Blood pressure
  3. Caffeine intake
  4. Weak or absent peripheral pulses
Show the answer and explanation

Answer: C. Caffeine intake

Topic: Cardiovascular Risk Assessment

Caffeine intake is a lifestyle habit that can be altered and influences heart rate, blood pressure, and arrhythmia risk, making it a modifiable risk factor to assess.

Why the others are wrong

  • A – JVD reflects existing hemodynamic changes; it cannot be changed by lifestyle.
  • B – Blood pressure is a measured sign, not a modifiable risk factor itself.
  • D – Peripheral pulses are assessment findings, not a factor that can be modified.

Remember: Caffeine is a lifestyle habit you can cut to protect the heart.

Question adapted from Health Alterations, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

71Question

The medication hydroxyurea is effective for sickle cell disease because it

  1. Helps produces more platelets.
  2. Reduces the sickling of the cell.
  3. Removes debris in the blood vessel.
  4. Decreases the volume of blood cells in circulation.
Show the answer and explanation

Answer: B. Reduces the sickling of the cell.

Topic: Sickle Cell Pharmacology

Hydroxyurea works by increasing fetal hemoglobin production, which interferes with sickle hemoglobin polymerization and thus reduces red cell sickling and related complications and improves oxygen delivery.

Why the others are wrong

  • A – Hydroxyurea does not increase platelets; it may suppress bone marrow.
  • C – Hydroxyurea does not clear vascular debris; it alters hemoglobin composition.
  • D – Hydroxyurea does not lower overall red cell volume; it raises fetal hemoglobin.

Remember: More fetal hemoglobin = fewer sickle cells.

Question adapted from Health Alterations, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

72Question

Mr. Johnson, a 58-year-old man, has a history of hypertension, high cholesterol, and a family history of CAD. He presents with complaints of chest pain during physical activity. A cardiac assessment reveals signs of stable angina. What is the primary cause of CAD?

  1. Arteriosclerosis
  2. Excessive alcohol consumption
  3. Chronic stress
  4. Atherosclerosis
Show the answer and explanation

Answer: D. Atherosclerosis

Topic: Coronary Artery Disease

Atherosclerosis is the buildup of lipid‑rich plaques within coronary arteries, leading to luminal narrowing and reduced myocardial blood flow, which underlies stable angina and coronary artery disease.

Why the others are wrong

  • A – Arteriosclerosis describes generalized arterial wall thickening, not plaque formation causing CAD.
  • B – Excessive alcohol can worsen risk factors yet is not the primary etiology of CAD.
  • C – Chronic stress contributes to risk but does not directly cause coronary artery disease.

Remember: Plaque buildup narrows coronary arteries, causing angina.

Question adapted from Health Alterations, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

73Question

A physician orders a patient to take Benztropine (Cogentin). The patient has never taken this medication before and is due to take the first dose at 1000. What statement by the patient requires you to hold the dose and notify the physician?

  1. "I had a PET scan last week."
  2. "I forgot to tell the doctor I take eye drops for my glaucoma."
  3. "I take aspirin once day."
  4. "My hands are experiencing tremors at rest."
Show the answer and explanation

Answer: B. "I forgot to tell the doctor I take eye drops for my glaucoma."

Topic: Benztropine Contraindications

Benztropine is an anticholinergic medication that can significantly increase intraocular pressure. It is strictly contraindicated in patients with glaucoma, as it can precipitate an acute angle-closure glaucoma crisis, requiring the nurse to hold the dose.

Why the others are wrong

  • A – A recent PET scan does not interact with or contraindicate benztropine administration.
  • C – Daily aspirin therapy is safe to use and does not interact with benztropine.
  • D – Resting tremors are an indication for benztropine, not a contraindication to its use.

Remember: Benztropine is anticholinergic; avoid it in patients with glaucoma.

Question adapted from Health Alterations, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

74Question

What is the main symptom of CAD that is often experienced during physical activity?

  1. Weakness
  2. Diaphoresis
  3. Shortness of breath
  4. Angina
Show the answer and explanation

Answer: D. Angina

Topic: Coronary Artery Disease

Angina, a pressure or squeezing chest discomfort, is the hallmark symptom of coronary artery disease that typically appears with exertion because myocardial oxygen demand exceeds supply and may radiate to the jaw or left arm.

Why the others are wrong

  • A – General weakness is nonspecific and not the defining exertional manifestation of coronary disease.
  • B – Sweating can be a secondary response, not the primary symptom indicating myocardial ischemia.
  • C – Dyspnea may accompany CAD but chest pain is the classic exertional sign.

Remember: Exercise‑triggered chest pressure = angina

Question adapted from Health Alterations, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

75Question

Which characteristic distinguishes Tuberculosis (TB) from other respiratory illnesses?

  1. Rapid onset of symptoms within 24 hours
  2. Accumulation of purulent fluid in the lower lobes of the lungs
  3. Formation of caseous necrosis in the center of a tubercle
  4. Infection primarily caused by rhinovirus
Show the answer and explanation

Answer: C. Formation of caseous necrosis in the center of a tubercle

Topic: Tuberculosis Pathophysiology

Tuberculosis is characterized by granulomatous lesions (tubercles) that develop central caseous necrosis, a cheese‑like core unique among respiratory infections, reflecting the host’s delayed‑type hypersensitivity response to Mycobacterium tuberculosis.

Why the others are wrong

  • A – TB symptoms develop insidiously over weeks, not within 24 hours.
  • B – Purulent lower‑lobe fluid suggests bacterial pneumonia, not TB.
  • D – Rhinovirus causes the common cold, not Mycobacterium tuberculosis.

Remember: TB’s hallmark: cheese‑like center in its granuloma.

Question adapted from Health Alterations, by Open Resources for Nursing (Open RN); K. Ernstmeyer and E. Christman, editors (WisTech Open), licensed CC BY 4.0; wording and option order may differ from the book. The explanation is ours, checked against the book's answer.

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