Respiratory and cardiovascular disorders

25 Kerala PSC Staff Nurse Gr II practice questions on Respiratory and cardiovascular disorders, part of Medical Surgical Nursing. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Easy
A patient with suspected acute myocardial infarction and no aspirin allergy should be given:
1. AChewed aspirin 300 mg
2. BOral ibuprofen 400 mg
3. CSwallowed paracetamol 500 mg
4. DIM diclofenac 75 mg
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Answer: A · Chewed aspirin 300 mg
Aspirin blocks thromboxane formation and stops further platelet aggregation on the ruptured plaque. Chewing a non-enteric dose gives a quick effect, and early aspirin lowers death from MI. It is given as soon as MI is suspected, along with ECG and referral for reperfusion.
- B: Ibuprofen is an NSAID that increases cardiac risk and is not given.
- C: Paracetamol has no antiplatelet effect.
- D: Intramuscular injections are avoided in MI and diclofenac does not help.
Question 2 · Easy
Long-term streptomycin injection for tuberculosis can damage the:
1. APeripheral nerves of the feet
2. BOptic nerve
3. CRetina
4. DEighth cranial nerve
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Answer: D · Eighth cranial nerve
Streptomycin, an aminoglycoside, is toxic to the eighth (vestibulocochlear) nerve and the kidneys. Patients may develop giddiness, tinnitus and hearing loss, which can be permanent. It is avoided in pregnancy because it can cause deafness in the baby.
- A: Peripheral neuropathy is caused by isoniazid.
- B: Optic nerve damage is caused by ethambutol.
- C: Retinal damage is not an effect of streptomycin.
Question 3 · Easy
A patient on four antitubercular drugs reports blurred vision and difficulty telling red from green. The drug most likely responsible is:
1. AEthambutol
2. BRifampicin
3. CIsoniazid
4. DPyrazinamide
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Answer: A · Ethambutol
Ethambutol can cause optic neuritis, with blurred vision and loss of red-green colour discrimination. Vision is checked at the start and patients are told to report any change, which usually recovers if the drug is stopped early. Young children who cannot report visual change need careful dosing by weight.
- B: Rifampicin colours body fluids orange and causes hepatitis, not optic neuritis.
- C: Isoniazid mainly causes peripheral neuropathy and hepatitis.
- D: Pyrazinamide causes hepatitis and raised uric acid with joint pain.
Question 4 · Easy
The drug of first choice to relieve an acute attack of bronchial asthma is inhaled:
1. ASalbutamol
2. BMontelukast
3. CSodium cromoglycate
4. DBudesonide
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Answer: A · Salbutamol
Salbutamol is a short-acting beta-2 agonist that relaxes bronchial smooth muscle within minutes. It is used by metered-dose inhaler with spacer or by nebuliser for acute attacks. Tremor and tachycardia are common side effects.
- B: Montelukast is an oral controller drug, not a reliever.
- C: Cromoglycate is a preventer with no effect during an attack.
- D: Budesonide is an inhaled steroid that controls inflammation over days.
Question 5 · Easy
Spoon-shaped nails (koilonychia) are a sign of:
1. AIron deficiency anaemia
2. BVitamin B12 deficiency
3. CHaemophilia
4. DPolycythaemia vera
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Answer: A · Iron deficiency anaemia
Long-standing iron deficiency makes the nails thin, flat and then concave like a spoon. Other signs are pallor, angular stomatitis, glossitis and pica. Iron deficiency is the commonest anaemia in Indian women and children, and the blood picture is microcytic and hypochromic.
- B: B12 deficiency causes a smooth red tongue and neuropathy, not koilonychia.
- C: Haemophilia causes bleeding into joints and muscles.
- D: Polycythaemia vera causes a ruddy face and itching after a bath.
Question 6 · Hard
A 66-year-old with COPD is drowsy. ABG: pH 7.32, PaCO2 62 mmHg, HCO3 32 mEq/L (normal pH 7.35-7.45, PaCO2 35-45, HCO3 22-26). The interpretation is:
1. APartly compensated respiratory acidosis
2. BUncompensated respiratory acidosis
3. CPartly compensated metabolic alkalosis
4. DFully compensated respiratory acidosis
Answer and explanation in LearnFree account
Question 7 · Hard
Ten minutes after a unit of packed red cells is started, the patient has chills, low back pain, fever and a BP of 86/50 mmHg. What should the nurse do first?
1. ASlow the transfusion and give paracetamol
2. BContinue the transfusion and inform the doctor
3. CRemove the IV cannula and apply pressure
4. DStop the transfusion and keep the vein open with saline
Answer and explanation in LearnFree account
Question 8 · Easy
For a patient with COPD who retains carbon dioxide, oxygen therapy is usually titrated to an SpO2 of:
1. A94-98%
2. B100%
3. C88-92%
4. D80-84%
Answer and explanation in LearnFree account
Question 9 · Medium
A thin patient with emphysema, barrel chest, pink colour and marked breathlessness at rest is classically described as a:
1. APink puffer
2. BBlue bloater
3. CFunnel chest
4. DPigeon chest
Answer and explanation in LearnFree account
Question 10 · Hard
A man with a stab wound to the right chest is breathless, BP 80/50 mmHg, with absent breath sounds on the right and the trachea pushed to the left. The priority action is:
1. ALay him flat and give oral fluids
2. BPrepare for immediate needle decompression
3. CApply a tight bandage around the chest
4. DSend him for an urgent chest X-ray first
Answer and explanation in LearnFree account
Question 11 · Medium
The drainage bottle of an underwater-seal chest drain must always be kept:
1. ABelow the level of the patient's chest
2. BOn the bed beside the patient
3. CLevel with the patient's shoulder
4. DAbove the patient's head
Answer and explanation in LearnFree account
Question 12 · Medium
Besides detecting Mycobacterium tuberculosis, the CBNAAT (GeneXpert) test used under NTEP also detects:
1. AAtypical mycobacteria
2. BIsoniazid resistance
3. CRifampicin resistance
4. DHIV co-infection
Answer and explanation in LearnFree account
Question 13 · Medium
Which of these is most likely to bring on a painful crisis in a patient with sickle cell disease?
1. ARegular folic acid tablets
2. BPlenty of oral fluids daily
3. CDehydration and cold exposure
4. DWearing warm clothing
Answer and explanation in LearnFree account
Question 14 · Medium
In an asthma action plan, a peak expiratory flow below 50% of the patient's personal best means:
1. AGreen zone, continue usual care
2. BNormal variation, no change
3. CRed zone, a medical emergency
4. DYellow zone, use more reliever
Answer and explanation in LearnFree account
Question 15 · Easy
Pursed-lip breathing is taught to patients with emphysema to:
1. AKeep small airways open during expiration
2. BIncrease the speed of inspiration
3. CLoosen thick secretions from the bronchial tree
4. DStrengthen the abdominal muscles
Answer and explanation in LearnFree account
Question 16 · Hard
A COPD patient has smoked 10 cigarettes a day for 30 years. His smoking history in pack-years is:
1. A30 pack-years
2. B300 pack-years
3. C60 pack-years
4. D15 pack-years
Answer and explanation in LearnFree account
Question 17 · Easy
Which position gives the most relief to a patient with acute left heart failure and breathlessness?
1. ALeft lateral position
2. BHigh Fowler's with legs down
3. CTrendelenburg position
4. DFlat supine with legs raised
Answer and explanation in LearnFree account
Question 18 · Medium
A hypertensive patient started on amlodipine complains that both ankles swell by evening. This is best explained by:
1. ADilatation of the arterioles
2. BWorsening heart failure
3. CAn allergic drug reaction
4. DRetention of sodium by kidneys
Answer and explanation in LearnFree account
Question 19 · Medium
A child with beta-thalassaemia major on regular blood transfusions needs which drug to prevent organ damage?
1. ADesferrioxamine
2. BFolic acid
3. CErythropoietin injections
4. DVitamin K
Answer and explanation in LearnFree account
Question 20 · Medium
A patient with heart failure is started on furosemide. The nurse should watch most closely for a low serum level of:
1. ACalcium
2. BPotassium
3. CGlucose
4. DSodium bicarbonate
Answer and explanation in LearnFree account
Question 21 · Easy
A patient with pernicious anaemia needs lifelong:
1. ABlood transfusion
2. BOral iron tablets
3. CIntramuscular vitamin B12
4. DOral folic acid
Answer and explanation in LearnFree account
Question 22 · Medium
To control hypertension, the WHO advises adults to limit their daily salt intake to less than:
1. A15 grams
2. B10 grams
3. C5 grams
4. D2 grams
Answer and explanation in LearnFree account
Question 23 · Easy
Haemophilia A is caused by a deficiency of clotting factor:
1. AIX
2. BXIII
3. CXI
4. DVIII
Answer and explanation in LearnFree account
Question 24 · Hard
Four months into antitubercular treatment, a malnourished patient with diabetes complains of burning and numbness of both feet. Which drug should the nurse expect to be added?
1. AThiamine
2. BPyridoxine
3. CPrednisolone
4. DVitamin D
Answer and explanation in LearnFree account
Question 25 · Medium
A patient with angina is taught to take sublingual nitroglycerin. If chest pain is not relieved 5 minutes after the first tablet, the patient should:
1. ACall for emergency help immediately
2. BWait another hour before acting
3. CSwallow two tablets with water
4. DLie flat and raise both legs
Answer and explanation in LearnFree account

Respiratory and cardiovascular disorders

A patient with suspected acute myocardial infarction and no aspirin allergy should be given:

Long-term streptomycin injection for tuberculosis can damage the:

A patient on four antitubercular drugs reports blurred vision and difficulty telling red from green. The drug most likely responsible is:

The drug of first choice to relieve an acute attack of bronchial asthma is inhaled:

Spoon-shaped nails (koilonychia) are a sign of:

A 66-year-old with COPD is drowsy. ABG: pH 7.32, PaCO2 62 mmHg, HCO3 32 mEq/L (normal pH 7.35-7.45, PaCO2 35-45, HCO3 22-26). The interpretation is:

Ten minutes after a unit of packed red cells is started, the patient has chills, low back pain, fever and a BP of 86/50 mmHg. What should the nurse do first?

For a patient with COPD who retains carbon dioxide, oxygen therapy is usually titrated to an SpO2 of:

A thin patient with emphysema, barrel chest, pink colour and marked breathlessness at rest is classically described as a:

A man with a stab wound to the right chest is breathless, BP 80/50 mmHg, with absent breath sounds on the right and the trachea pushed to the left. The priority action is:

The drainage bottle of an underwater-seal chest drain must always be kept:

Besides detecting Mycobacterium tuberculosis, the CBNAAT (GeneXpert) test used under NTEP also detects:

Which of these is most likely to bring on a painful crisis in a patient with sickle cell disease?

In an asthma action plan, a peak expiratory flow below 50% of the patient's personal best means:

Pursed-lip breathing is taught to patients with emphysema to:

A COPD patient has smoked 10 cigarettes a day for 30 years. His smoking history in pack-years is:

Which position gives the most relief to a patient with acute left heart failure and breathlessness?

A hypertensive patient started on amlodipine complains that both ankles swell by evening. This is best explained by:

A child with beta-thalassaemia major on regular blood transfusions needs which drug to prevent organ damage?

A patient with heart failure is started on furosemide. The nurse should watch most closely for a low serum level of:

A patient with pernicious anaemia needs lifelong:

To control hypertension, the WHO advises adults to limit their daily salt intake to less than:

Haemophilia A is caused by a deficiency of clotting factor:

Four months into antitubercular treatment, a malnourished patient with diabetes complains of burning and numbness of both feet. Which drug should the nurse expect to be added?

A patient with angina is taught to take sublingual nitroglycerin. If chest pain is not relieved 5 minutes after the first tablet, the patient should: