CJE MED-SURG 1
COMPREHENSIVE
STUDY GUIDE
SECTION 1: CARDIOVASCULAR & PERIPHERAL VASCULAR
ASSESSMENT
QUESTION 1
When the home health nurse visits a 90-year-old client after repair of a hip fracture, the client
states, "The back of my left leg sure does hurt. Can you rub it a bit for me?" Upon
assessment of the client's lower extremities, the nurse places a call to the health care
provider. What assessment findings prompted the call? Select all that apply.
ANSWER
• There is warmth and redness to the client's left leg.
• Left leg appears larger than the right.
• Weak pedal pulses - May indicate compromised circulation.
RATIONALE / EXPLANATION
These findings suggest possible deep vein thrombosis (DVT). Warmth, redness, swelling, and
pain in the calf after hip surgery are classic DVT signs. NEVER massage a suspected DVT as it
could dislodge a clot causing pulmonary embolism.
QUESTION 2
A client is seen in the health care provider's office for high blood pressure. The client is
started on a diuretic and an ACE inhibitor. The client is asked to log their blood pressure
readings for five days and bring the log to the office. Which readings demonstrate that the
medication is effective?
ANSWER
180/98 mmHg, 180/88 mmHg, 164/88 mmHg, 156/80 mmHg, 154/78 mmHg
RATIONALE / EXPLANATION
These readings show a progressive decrease in blood pressure over time, indicating the
medications are working effectively. The trend shows improvement from hypertensive readings
toward more normal values.
Page 1 of 19
,QUESTION 3
The home health nurse cares for a client with peripheral vascular disease and assesses the
client's feet. What is important for the nurse to include in the client's plan of care?
ANSWER
Elevate the lower extremities whenever possible
RATIONALE / EXPLANATION
Elevation helps reduce edema and improve venous return. For peripheral vascular disease,
positioning and circulation promotion are key interventions.
QUESTION 4
The floor nurse assesses a client's dialysis fistula and determines that it is non-functional.
The nurse intervenes by notifying the health care provider immediately. What prompted the
nurse to contact the HCP?
ANSWER
The client cannot survive without the dialysis procedure.
RATIONALE / EXPLANATION
A non-functional fistula is a medical emergency for dialysis-dependent patients. Without dialysis
access, the client cannot receive life-sustaining treatment, making immediate notification
essential.
Page 2 of 19
, SECTION 2: FLUID & ELECTROLYTE BALANCE
QUESTION 5
A client is in the observation unit of the emergency department with lightheadedness upon
standing, dry mouth, and a headache. The client reports running a marathon two days ago
and has been feeling unwell since then. Blood pressure is 92/60, temperature 101.1°F
(38.3°C), respiratory rate 22, heart rate 112, and oxygen saturation 94%. Serum laboratory
tests reveal hyponatremia and hyperkalemia. The client is only able to urinate 30 mL of very
dark urine. What does the nurse anticipate will be in the client's immediate plan of care?
ANSWER
• Monitor intake and output - Yes, this is critical for assessing fluid balance in a
potentially dehydrated client.
• Intravenous fluid replacement - Yes, this is essential to correct hypovolemia,
electrolyte imbalances, and prevent further complications.
• Bedrest - Yes, indicated due to hypotension and risk of falls or further
complications.
RATIONALE / EXPLANATION
The client shows classic signs of severe dehydration: hypotension, tachycardia, concentrated
urine, electrolyte imbalances, and orthostatic symptoms following strenuous exercise. IV fluids,
I&O monitoring, and bedrest are essential interventions.
QUESTION 6
A client was abducted a year ago by an estranged spouse and kept tied in the basement
against her will. The client was finally able to break free and was started on total parenteral
nutrition (TPN) in the emergency department. Which finding most likely led to the
implementation of TPN?
ANSWER
Total protein level of 4.0 g/dL.
RATIONALE / EXPLANATION
Normal total protein is 6.0-8.3 g/dL. A level of 4.0 g/dL indicates severe protein malnutrition
requiring TPN to provide complete nutrition intravenously when the GI tract cannot be used or is
inadequate.
Page 3 of 19
COMPREHENSIVE
STUDY GUIDE
SECTION 1: CARDIOVASCULAR & PERIPHERAL VASCULAR
ASSESSMENT
QUESTION 1
When the home health nurse visits a 90-year-old client after repair of a hip fracture, the client
states, "The back of my left leg sure does hurt. Can you rub it a bit for me?" Upon
assessment of the client's lower extremities, the nurse places a call to the health care
provider. What assessment findings prompted the call? Select all that apply.
ANSWER
• There is warmth and redness to the client's left leg.
• Left leg appears larger than the right.
• Weak pedal pulses - May indicate compromised circulation.
RATIONALE / EXPLANATION
These findings suggest possible deep vein thrombosis (DVT). Warmth, redness, swelling, and
pain in the calf after hip surgery are classic DVT signs. NEVER massage a suspected DVT as it
could dislodge a clot causing pulmonary embolism.
QUESTION 2
A client is seen in the health care provider's office for high blood pressure. The client is
started on a diuretic and an ACE inhibitor. The client is asked to log their blood pressure
readings for five days and bring the log to the office. Which readings demonstrate that the
medication is effective?
ANSWER
180/98 mmHg, 180/88 mmHg, 164/88 mmHg, 156/80 mmHg, 154/78 mmHg
RATIONALE / EXPLANATION
These readings show a progressive decrease in blood pressure over time, indicating the
medications are working effectively. The trend shows improvement from hypertensive readings
toward more normal values.
Page 1 of 19
,QUESTION 3
The home health nurse cares for a client with peripheral vascular disease and assesses the
client's feet. What is important for the nurse to include in the client's plan of care?
ANSWER
Elevate the lower extremities whenever possible
RATIONALE / EXPLANATION
Elevation helps reduce edema and improve venous return. For peripheral vascular disease,
positioning and circulation promotion are key interventions.
QUESTION 4
The floor nurse assesses a client's dialysis fistula and determines that it is non-functional.
The nurse intervenes by notifying the health care provider immediately. What prompted the
nurse to contact the HCP?
ANSWER
The client cannot survive without the dialysis procedure.
RATIONALE / EXPLANATION
A non-functional fistula is a medical emergency for dialysis-dependent patients. Without dialysis
access, the client cannot receive life-sustaining treatment, making immediate notification
essential.
Page 2 of 19
, SECTION 2: FLUID & ELECTROLYTE BALANCE
QUESTION 5
A client is in the observation unit of the emergency department with lightheadedness upon
standing, dry mouth, and a headache. The client reports running a marathon two days ago
and has been feeling unwell since then. Blood pressure is 92/60, temperature 101.1°F
(38.3°C), respiratory rate 22, heart rate 112, and oxygen saturation 94%. Serum laboratory
tests reveal hyponatremia and hyperkalemia. The client is only able to urinate 30 mL of very
dark urine. What does the nurse anticipate will be in the client's immediate plan of care?
ANSWER
• Monitor intake and output - Yes, this is critical for assessing fluid balance in a
potentially dehydrated client.
• Intravenous fluid replacement - Yes, this is essential to correct hypovolemia,
electrolyte imbalances, and prevent further complications.
• Bedrest - Yes, indicated due to hypotension and risk of falls or further
complications.
RATIONALE / EXPLANATION
The client shows classic signs of severe dehydration: hypotension, tachycardia, concentrated
urine, electrolyte imbalances, and orthostatic symptoms following strenuous exercise. IV fluids,
I&O monitoring, and bedrest are essential interventions.
QUESTION 6
A client was abducted a year ago by an estranged spouse and kept tied in the basement
against her will. The client was finally able to break free and was started on total parenteral
nutrition (TPN) in the emergency department. Which finding most likely led to the
implementation of TPN?
ANSWER
Total protein level of 4.0 g/dL.
RATIONALE / EXPLANATION
Normal total protein is 6.0-8.3 g/dL. A level of 4.0 g/dL indicates severe protein malnutrition
requiring TPN to provide complete nutrition intravenously when the GI tract cannot be used or is
inadequate.
Page 3 of 19
