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1. A patient arrives at the emergency department complaining of midsternal chest pain. Which of the
following nursing action should take priority?

A. A complete history with emphasis on preceding events.

B. An electrocardiogram.
C. Careful assessment of vital signs.
D. Chest exam with auscultation.

2. A patient has been hospitalized with pneumonia and is about to be discharged. A nurse provides
discharge instructions to a patient and his family. Which misunderstanding by the family indicates the need
for more detailed information?

A. The patient may resume normal home activities as tolerated but should avoid physical exertion and get adequate
rest.
B. The patient should resume a normal diet with emphasis on nutritious, healthy foods.
C. The patient may discontinue the prescribed course of oral antibiotics once the symptoms have completely
resolved.
D. The patient should continue use of the incentive spirometer to keep airways open and free of secretions.

3. A nurse is caring for an elderly Vietnamese patient in the terminal stages of lung cancer. Many family
members are in the room around the clock performing unusual rituals and bringing ethnic foods. Which of
the following actions should the nurse take?

A. Restrict visiting hours and ask the family to limit visitors to two at a time.
B. Notify visitors with a sign on the door that the patient is limited to clear fluids only with no solid food allowed.
C. If possible, keep the other bed in the room unassigned to provide privacy and comfort to the family.
D. Contact the physician to report the unusual rituals and activities.

4. The charge nurse on the cardiac unit is planning assignments for the day. Which of the following is the
most appropriate assignment for the float nurse that has been reassigned from labor and delivery?

A. A one-week postoperative coronary bypass patient, who is being evaluated for placement of a pacemaker prior to
discharge.

B. A suspected myocardial infarction patient on telemetry, just admitted from the Emergency Department and
scheduled for an angiogram.
C. A patient with unstable angina being closely monitored for pain and medication titration.
D. A postoperative valve replacement patient who was recently admitted to the unit because all surgical beds were
filled.

5. A newly diagnosed 8-year-old child with type I diabetes mellitus and his mother are receiving diabetes
education prior to discharge. The physician has prescribed Glucagon for emergency use. The mother asks
the purpose of this medication. Which of the following statements by the nurse is correct?

A. Glucagon enhances the effect of insulin in case the blood sugar remains high one hour after injection.
B. Glucagon treats hypoglycemia resulting from insulin overdose.
C. Glucagon treats lipoatrophy from insulin injections.
D. Glucagon prolongs the effect of insulin, allowing fewer injections.

6. An infant with congestive heart failure is receiving diuretic therapy at home. Which of the following
symptoms would indicate that the dosage may need to be increased?

A. Sudden weight gain.

B. Decreased blood pressure.
C. Slow, shallow breathing.
D. Bradycardia.

7. A patient taking Dilantin (phenytoin) for a seizure disorder is experiencing breakthrough seizures. A blood
sample is taken to determine the serum drug level. Which of the following would indicate a sub-therapeutic
level?

A. 15 mcg/mL.
B. 4 mcg/mL.
C. 10 mcg/dL.
D. 5 mcg/dL.

8. A patient arrives at the emergency department complaining of back pain. He reports taking at least 3
acetaminophen tablets every three hours for the past week without relief. Which of the following symptoms
suggests acetaminophen toxicity?

A. Tinnitus.
B. Diarrhea.
C. Hypertension.
D. Hepatic damage.

9. A nurse is caring for a cancer patient receiving subcutaneous morphine sulfate for pain. Which of the
following nursing actions is most important in the care of this patient?

A. Monitor urine output.

B. Monitor respiratory rate.
C. Monitor heart rate.
D. Monitor temperature.

10. A patient arrives at the emergency department with severe lower leg pain after a fall in a touch football
game. Following routine triage, which of the following is the appropriate next step in assessment and
treatment?

A. Apply heat to the painful area.

B. Apply an elastic bandage to the leg.
C. X-ray the leg.
D. Give pain medication.

11. A nurse caring for several patients on the cardiac unit is told that one is scheduled for implantation of an
automatic internal cardioverter-defibrillator. Which of the following patients is most likely to have this
procedure?

A. A patient admitted for myocardial infarction without cardiac muscle damage.

B. A post-operative coronary bypass patient, recovering on schedule.
C. A patient with a history of ventricular tachycardia and syncopal episodes.
D. A patient with a history of atrial tachycardia and fatigue.

12. A patient is scheduled for a magnetic resonance imaging (MRI) scan for suspected lung cancer. Which of
the following is a contraindication to the study for this patient?

A. The patient is allergic to shellfish.

B. The patient has a pacemaker.

C. The patient suffers from claustrophobia.

D. The patient takes antipsychotic medication.

13. A nurse calls a physician with the concern that a patient has developed a pulmonary embolism. Which of
the following symptoms has the nurse most likely observed?

A. The patient is somnolent with decreased response to the family.

B. The patient suddenly complains of chest pain and shortness of breath.
C. The patient has developed a wet cough and the nurse hears crackles on auscultation of the lungs.
D. The patient has a fever, chills, and loss of appetite.

14. A patient comes to the emergency department with abdominal pain. Work-up reveals the presence of a
rapidly enlarging abdominal aortic aneurysm. Which of the following actions should the nurse expect?

A. The patient will be admitted to the medicine unit for observation and medication.
B. The patient will be admitted to the day surgery unit for sclerotherapy.
C. The patient will be admitted to the surgical unit and resection will be scheduled.
D. The patient will be discharged home to follow-up with his cardiologist in 24 hours.

15. A patient with leukemia is receiving chemotherapy that is known to depress bone marrow. A CBC
(complete blood count) reveals a platelet count of 25,000/microliter. Which of the following actions related
specifically to the platelet count should be included on the nursing care plan?

A. Monitor for fever every 4 hours.

B. Require visitors to wear respiratory masks and protective clothing.
C. Consider transfusion of packed red blood cells.
D. Check for signs of bleeding, including examination of urine and stool for blood.

16. A patient is undergoing the induction stage of treatment for leukemia. The nurse teaches family members
about infectious precautions. Which of the following statements by family members indicates that the family
needs more education?

A. We will bring in books and magazines for entertainment.

B. We will bring in personal care items for comfort.
C. We will bring in fresh flowers to brighten the room.
D. We will bring in family pictures and get well cards.

17. A nurse is caring for a patient with acute lymphoblastic leukemia (ALL). Which of the following is the
most likely age range of the patient?

A. 3-10 years.
B. 25-35 years.
C. 45-55 years.
D. over 60 years.

18. A patient is admitted to the oncology unit for diagnosis of suspected Hodgkins disease. Which of the
following symptoms is typical of Hodgkins disease?

A. Painful cervical lymph nodes.

B. Night sweats and fatigue.
C. Nausea and vomiting.
D. Weight gain.

19. The Hodgkins disease patient described in the question above undergoes a lymph node biopsy for
definitive diagnosis. If the diagnosis of Hodgkins disease were correct, which of the following cells would
the pathologist expect to find?

A. Reed-Sternberg cells.
B. Lymphoblastic cells.
C. Gauchers cells.
D. Rieders cells

20. A patient is about to undergo bone marrow aspiration and biopsy and expresses fear and anxiety about
the procedure. Which of the following is the most effective nursing response?

A. Warn the patient to stay very still because the smallest movement will increase her pain.
B. Encourage the family to stay in the room for the procedure.
C. Stay with the patient and focus on slow, deep breathing for relaxation.
D. Delay the procedure to allow the patient to deal with her feelings.

Answers and Rationale

1. Answer: C. Careful assessment of vital signs.

The priority nursing action for a patient arriving at the ED in distress is always assessment of vital signs. This
indicates the extent of physical compromise and provides a baseline by which to plan further assessment and
treatment. A thorough medical history, including onset of symptoms, will be necessary and it is likely that an
electrocardiogram will be performed as well, but these are not the first priority. Similarly, chest exam with auscultation
may offer useful information after vital signs are assessed.

2. Answer: C. The patient may discontinue the prescribed course of oral antibiotics once the symptoms have
completely resolved.

It is always critical that patients being discharged from the hospital take prescribed medications as instructed. In the
case of antibiotics, a full course must be completed even after symptoms have resolved to prevent incomplete
eradication of the organism and recurrence of infection. The patient should resume normal activities as tolerated, as
well as a nutritious diet. Continued use of the incentive spirometer after discharge will speed recovery and improve
lung function.

3. Answer: C. If possible, keep the other bed in the room unassigned to provide privacy and comfort to the
family.

When a family member is dying, it is most helpful for nursing staff to provide a culturally sensitive environment to the
degree possible within the hospital routine. In the Vietnamese culture, it is important that the dying be surrounded by
loved ones and not left alone. Traditional rituals and foods are thought to ease the transition to the next life. When
possible, allowing the family privacy for this traditional behavior is best for them and the patient. Answers A, B, and D
are incorrect because they create unnecessary conflict with the patient and family.

4. Answer: A. A one-week postoperative coronary bypass patient, who is being evaluated for placement of a
pacemaker prior to discharge.

The charge nurse planning assignments must consider the skills of the staff and the needs of the patients.
The labor and delivery nurse who is not experienced with the needs of cardiac patients should be assigned to those
with the least acute needs. The patient who is one-week post-operative and nearing discharge is likely to require
routine care. A new patient admitted with suspected MI and scheduled for angiography would require continuous
assessment as well as coordination of care that is best carried out by experienced staff. The unstable patient requires
staff that can immediately identify symptoms and respond appropriately. A postoperative patient also requires close
monitoring and cardiac experience.

5. Answer: B. Glucagon treats hypoglycemia resulting from insulin overdose.

Glucagon is given to treat insulin overdose in an unresponsive patient. Following Glucagon administration, the patient
should respond within 15-20 minutes at which time oral carbohydrates should be given. Glucagon reverses rather
than enhances or prolongs the effects of insulin. Lipoatrophy refers to the effect of repeated insulin injections on
subcutaneous fat.

6. Answer: A. Sudden weight gain.

Weight gain is an early symptom of congestive heart failure due to accumulation of fluid. When diuretic therapy is
inadequate, one would expect an increase in blood pressure, tachypnea, and tachycardia to result.

7. Answer: B. 4 mcg/mL.

The therapeutic serum level for Dilantin is 10 20 mcg/mL. A level of 4 mcg/mL is subtherapeutic and may be caused
by patient non-compliance or increased metabolism of the drug. A level of 15 mcg/mL is therapeutic. Choices C and
D are expressed in mcg/dL, which is the incorrect unit of measurement.

8. Answer: D. Hepatic damage.

Acetaminophen in even moderately large doses can cause serious liver damage that may result in death. Immediate
evaluation of liver function is indicated with consideration of N-acetylcysteine administration as an antidote. Tinnitus is
associated with aspirin overdose, not acetaminophen. Diarrhea and hypertension are not associated with
acetaminophen.

9. Answer: B. Monitor respiratory rate.

Morphine sulfate can suppress respiration and respiratory reflexes, such as cough. Patients should be monitored
regularly for these effects to avoid respiratory compromise. Morphinesulfate does not significantly affect urine output,
heart rate, or body temperature.

10. Answer: C. X-ray the leg.

Following triage, an x-ray should be performed to rule out fracture. Ice, not heat, should be applied to a recent sports
injury. An elastic bandage may be applied and pain medication given once fracture has been excluded.

11. Answer: C. A patient with a history of ventricular tachycardia and syncopal episodes.

An automatic internal cardioverter-defibrillator delivers an electric shock to the heart to terminate episodes of
ventricular tachycardia and ventricular fibrillation. This is necessary in a patient with significant ventricular symptoms,
such as tachycardia resulting in syncope. A patient with myocardial infarction that resolved with no permanent cardiac
damage would not be a candidate. A patient recovering well from coronary bypass would not need the device. Atrial
tachycardia is less serious and is treated conservatively with medication and cardioversion as a last resort.

12. Answer: B. The patient has a pacemaker.

The implanted pacemaker will interfere with the magnetic fields of the MRI scanner and may be deactivated by them.
Shellfish/iodine allergy is not a contraindication because the contrast used in MRI scanning is not iodine-based. Open
MRI scanners and anti-anxiety medications are available for patients with claustrophobia. Psychiatric medication is
not a contraindication to MRI scanning.

13. Answer: B. The patient suddenly complains of chest pain and shortness of breath.

Typical symptoms of pulmonary embolism include chest pain, shortness of breath, and severe anxiety. The physician
should be notified immediately. A patient with pulmonary embolism will not be sleepy or have a cough with crackles
on exam. A patient with fever, chills and loss of appetite may be developing pneumonia.

14. Answer: C. The patient will be admitted to the surgical unit and resection will be scheduled.

A rapidly enlarging abdominal aortic aneurysm is at significant risk of rupture and should be resected as soon as
possible. No other appropriate treatment options currently exist.

15. Answer: D. Check for signs of bleeding, including examination of urine and stool for blood.

A platelet count of 25,000/microliter is severely thrombocytopenic and should prompt the initiation of bleeding
precautions, including monitoring urine and stool for evidence of bleeding. Monitoring for fever and requiring
protective clothing are indicated to prevent infection if white blood cells are decreased. Transfusion of red cells is
indicated for severe anemia.

16. Answer: C. We will bring in fresh flowers to brighten the room.

During induction chemotherapy, the leukemia patient is severely immunocompromised and at risk of serious infection.
Fresh flowers, fruit, and plants can carry microbes and should be avoided. Books, pictures, and other personal items
can be cleaned with antimicrobials before being brought into the room to minimize the risk of contamination.

17. Answer: A. 3-10 years.

The peak incidence of ALL is at 4 years (range 3-10). It is uncommon after the mid-teen years. The peak incidence of
chronic myelogenous leukemia (CML) is 45-55 years. The peak incidence of acute myelogenous leukemia (AML)
occurs at 60 years. Two-thirds of cases of chronic lymphocytic leukemia (CLL) occur after 60 years.

18. Answer: B. Night sweats and fatigue.

Symptoms of Hodgkins disease include night sweats, fatigue, weakness, and tachycardia. The disease is
characterized by painless, enlarged cervical lymph nodes. Weight loss occurs early in the disease. Nausea and
vomiting are not typically symptoms of Hodgkins disease.

19. Answer: A. Reed-Sternberg cells.

A definitive diagnosis of Hodgkins disease is made if Reed-Sternberg cells are found on pathologic examination of
the excised lymph node. Lymphoblasts are immature cells found in the bone marrow of patients with acute
lymphoblastic leukemia. Gauchers cells are large storage cells found in patients with Gauchers disease. Rieders
cells are myeloblasts found in patients with acute myelogenous leukemia.

20. Answer: C. Stay with the patient and focus on slow, deep breathing for relaxation.

Slow, deep breathing is the most effective method of reducing anxiety and stress. It reduces the level of carbon
dioxide in the brain to increase calm and relaxation. Warning the patient to remain still will likely increase her anxiety.
Encouraging family members to stay with the patient may make her worry about their anxiety as well as her own.
Delaying the procedure is unlikely to allay her fears.