Medical-Surgical Nursing Practice Test

Medical-Surgical Nursing Practice Test
December 2010 N.L.E.

Instruction: Select the correct answer for each following questions. Mark only one answer for each item by
encircling the letter of your choice. STRICTLY NO ERASURES ALLOWED
Nursing Practice 1 - 5
1. The nurse is giving instructions to a client who is going home with a cast on his leg. Which point is most critical?
a. Using crutches properly
b. Exercising joints above and below the cast, as ordered
c. Avoiding walking on a leg cast without the physician's permission
d. Reporting signs of impaired circulation
2. A client undergoes a surgical procedure that requires the use of general anesthesia. Following general anesthesia, the
client is most at risk for:
a. atelectasis. c. dehydration.
b. anemia. d. peripheral edema.
3. The nurse is caring for a client who recently underwent a tracheostomy. The first priority when caring for a client with a
tracheostomy is:
a. helping him communicate.
b. keeping his airway patent.
c. encouraging him to perform activities of daily living.
d. preventing him from developing an infection.
4. The nurse is working on a surgical floor. The nurse must logroll a client following a:
a. laminectomy. c. hemorrhoidectomy.
b. thoracotomy. d. cystectomy.
5. A client underwent cataract removal with an intraocular lens implant. The nurse is giving the client discharge instructions.
These instructions should include which of the following?
a. Avoid lifting objects weighing more than 5 lb (2.27 kg).
b. Lie on your abdomen when in bed.
c. Keep rooms brightly lit.
d. Avoid straining during bowel movement or bending at the waist.
6. Before weaning a client from a ventilator, which assessment parameter is most important for the nurse to review?
a. Fluid intake for the last 24 hours
b. Baseline arterial blood gas (ABG) levels
c. Prior outcomes of weaning
d. Electrocardiogram (ECG) results
7. A 25-year-old client asks the nurse how often and when she should perform breast self-examinations. The nurse should tell
her:
a. every month, timing isn't important.
b. every month, 7 to 10 days after menses starts.
c. every month, 7 to 10 days before menses starts.
d. breast self-examinations aren't necessary until after the first mammography.
8. A male client should be taught about testicular examinations:
a. when sexual activity starts. c. after age 40.
b. after age 60. d. before age 20.
9. When inserting a urinary catheter, the nurse can facilitate the insertion by asking the client to:
a. initiate a stream of urine
b. breathe deeply
c. turn to the side
d. hold the labia or shaft of penis
10. The nurse is caring for a client with a colostomy. The client tells the nurse that he makes small pin holes in the drainage bag
to help relieve gas. The nurse should teach him that this action:
a. destroys the odor-proof seal.
b. won't affect the colostomy system.
c. is appropriate for relieving the gas in a colostomy system.
d. destroys the moisture barrier seal.
11. The nurse must administer an enema to an adult client. The appropriate depth for inserting an enema into an average-sized
adult is:
a. 1 to 2 in (2.5 to 5 cm) c. 4 to 6 in (10 to 15 cm)
b. 3 to 4 in (7.5 to 10 cm) d. 6 to 8 in (15 to 20 cm)
12. The nurse must assess skin turgor of an elderly client. When evaluating skin turgor, the nurse should remember that:
a. overhydration causes the skin to tent.
b. dehydration causes the skin to appear edematous and spongy.
c. inelastic skin turgor is a normal part of aging.
SULTAN REVIEW GROUP-NURSING REVIEW
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d. normal skin turgor is moist and boggy.
13. A client who recently had a cerebrovascular accident requires a cane to ambulate. When teaching about cane use, the
rationale for holding a cane on the uninvolved side is to:
a. prevent leaning.
b. distribute weight away from the involved side.
c. maintain stride length.
d. prevent edema.
14. The nurse is developing a teaching plan for a client who must undergo an above-the-knee amputation of the left leg. After a
leg amputation, exercise of the remaining limb:
a. isn't necessary.
b. should begin immediately postoperatively.
c. should begin the day after surgery.
d. begins at a rehabilitation center.
15. The nurse is administering eyedrops to a client with glaucoma. To achieve maximum absorption, the nurse should instill the
eyedrop into the:
a. conjunctival sac. c. sclera.
b. pupil. d. vitreous humor.
16. The nurse is administering eardrops to an adult client. To straighten the ear canal in an adult client before instilling the
drops, the nurse should gently pull the:
a. auricle down and back. c. auricle up and back.
b. tragus down and back. d. tragus up and back.
17. The nurse is teaching a client about using vaginal medications. The nurse should instruct the client to:
a. use a tampon after insertion to increase medication absorption.
b. release and pull up on the applicator before removal.
c. never refrigerate suppositories.
d. use only a water-soluble lubricant when inserting a suppository.
18. The nurse is administering sublingual nitroglycerin to a client with chest pain. The nurse should place the medication:
a. in the cheek
b. on the tip of the tongue
c. under the tongue
d. under the lower lid of the eye
19. A client has an order for 5,000 U of subcutaneous (S.C.) heparin, every 12 hours. When injecting heparin S.C., the nurse
should:
a. aspirate after the injection.
b. use the Z-track method.
c. use a 90-degree angle for insertion.
d. always use the same injection site.
20. The nurse is preparing a client for insertion of an I.V. catheter. When selecting a site on the hand or arm for insertion of an
I.V. catheter, the nurse should:
a. choose a proximal site.
b. choose a distal site.
c. have the client hold his arm over his head.
d. leave the tourniquet on for at least 5 minutes.
21. The nurse is performing an assessment on a client who has developed a paralytic ileus. The client's bowel sounds will be:
a. hyperactive. c. high-pitched.
b. hypoactive. d. blowing.
22. The nurse is instructing a client about the use of antiembolism stockings. Antiembolism stockings help prevent deep vein
thrombosis (DVT) by:
a. encouraging ambulation to prevent pooling of blood.
b. providing warmth to the extremity.
c. elevating the extremity to prevent pooling of blood.
d. forcing blood into the deep venous system.
23. The nurse is caring for a client who's hypoglycemic. This client will have a blood glucose level:
a. below 70 mg/dl.
b. between 70 and 120 mg/dl.
c. between 120 and 180 mg/dl.
d. above 180 mg/dl.
24. A client has sustained a right tibial fracture and has just had a cast applied. Which instruction should the nurse provide in
his cast care?
a. Cover the cast with a blanket until the cast dries.
b. Keep your right leg elevated above heart level.
c. Use a knitting needle to scratch itches inside the cast.
d. A foul smell from the cast is normal.
25. The nurse is developing a teaching plan for a client with diabetes mellitus. A client with diabetes mellitus should:
a. use commercial preparations to remove corns.
b. cut toenails by rounding edges.
c. wash and inspect feet daily.
d. walk barefoot at least once each day.

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26. A client receiving total parental nutrition is prescribed a 24-hour urine test. When initiating a 24-hour urine specimen, the
collection time should:
a. start with the first voiding.
b. start after a known voiding.
c. always be with first morning urine.
d. always be the evening's last void as the last sample.
27. A client has undergone a left hemicolectomy for bowel cancer. Which activities prevent the occurrence of postoperative
pneumonia in this client?
a. Administering oxygen, coughing, breathing deeply, and maintaining bed rest
b. Coughing, breathing deeply, maintaining bed rest, and using an incentive spirometer
c. Coughing, breathing deeply, frequent repositioning, and using an incentive spirometer
d. Administering pain medications, frequent repositioning, and limiting fluid intake
28. The nurse is administering I.M. injections to an older client. The nurse should remember that an older client has:
a. less subcutaneous tissue and muscle mass than a younger client.
b. more subcutaneous tissue and less muscle mass than a younger client.
c. less subcutaneous tissue and more muscle mass than a younger client.
d. more subcutaneous tissue and muscle mass than a younger client.
29. The nurse is assessing an elderly client. When performing the assessment, the nurse should consider that one normal
aging change is:
a. cloudy vision. c. diminished reflexes.
b. incontinence. d. tremors.
30. A 42-year-old male complains of extreme fatigue and weakness after his 1st week of radiation therapy. Which of the
following responses by the nurse would best reassure him?
a. "These symptoms usually result from radiation therapy; however, we will continue to monitor your laboratory and X-ray
studies."
b. "These symptoms are part of your disease and can't be helped."
c. "Don't be concerned about these symptoms. Everybody feels this way after having radiation therapy."
d. "This is a good sign. It means that only the cancer cells are dying."
31. A female client experiences alopecia resulting from chemotherapy, prompting the nursing diagnoses of Disturbed body
image and Situational low self-esteem. Which of the following actions would best indicate that the client is meeting the goal
of improved body image and self-esteem?
a. The client requests that her family bring her makeup and wig.
b. The client begins to discuss the future with her family.
c. The client reports less disruption from pain and discomfort.
d. The client cries openly when discussing her disease.
32. An 18-year-old male has suffered a C5 spinal cord contusion that has resulted in quadriplegia. His mother is crying in the
waiting room 2 days after the injury has occurred. When you sit down to talk to her, she asks whether her son will ever play
football again. Which of the following responses would be best?
a. Reassure her that given time and motivation, he will return to normal function.
b. Advise her that it isn't in his best interest for her to be so upset, and explain the importance of moral support.
c. Reflect on how she's feeling, and encourage her to express other fears that she has about his injury.
d. Explain that you aren't sure, but you will call the physician to talk to her right away.
33. A client is in the first postoperative day after a total laryngectomy and radical neck dissection. Which of the following is a
priority goal?
a. Communicate by use of esophageal speech.
b. Improve body image and self-esteem.
c. Attain optimal levels of nutrition.
d. Maintain a patent airway.
34. A client undergoes a rhinoplasty to repair a nasal fracture in which displacement has caused an airway obstruction.
Postoperatively, the client swallows frequently and requires frequent changes of the mustache dressing, which is soiled with
bright red blood. Which is the best action for the nurse to take?
a. Offer the client an ice pack to decrease edema and control bleeding.
b. Offer the client a cold drink to soothe the throat.
c. Explain to the client that a tube was in the throat for the anesthetic.
d. Check the pharynx with a penlight for bleeding, and notify the physician.
35. Standard precautions were designed for the care of all clients in hospitals, regardless of their diagnosis or infection status.
Guidelines for standard precautions include:
a. immediately recapping used needles.
b. disposing of sharp instruments into an impervious container.
c. wearing gloves only for sterile procedures.
d. substituting regular eyeglasses for eye protection.
36. A client is admitted with a diagnosis of meningitis caused by Neisseria meningitides. The nurse should institute which type
of isolation precautions?
a. Contact precautions c. Airborne precautions
b. Droplet precautions d. Standard precautions
37. A client has undergone a colon resection. While turning him, wound dehiscence with evisceration occurs. The nurse's first
response is to:
a. call the physician.
b. place saline-soaked sterile dressings on the wound.

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c. take a blood pressure and pulse.
d. pull the dehiscence closed.
38. A client who recently experienced a stroke tells the nurse that he has double vision. Which nursing intervention is the most
appropriate?
a. Encourage the client to close his eyes.
b. Alternately patch one eye every 2 hours.
c. Turn out the lights in the room.
d. Instill artificial tears.
39. A client is hospitalized with an exacerbation of his chronic gastritis. When assessing his nutritional status, the nurse should
expect a deficiency in:
a. vitamin A. c. vitamin B12
b. vitamin B6 d. vitamin C
40. The nurse is conducting a screening for colorectal cancer. The client with the highest risk of colorectal cancer is a:
a. 52-year-old man with a family history of polyposis.
b. 32-year-old woman with a history of skin cancer.
c. 61-year-old man with a history of gastric ulcers.
d. 42-year-old man following a low-fat, 1,800-calorie diet.
41. The nurse is teaching a client how to irrigate his stoma. Which action indicates that the client needs more teaching?
a. Hanging the irrigation bag 24 to 36 in (60 to 90 cm) above the stoma
b. Filling the irrigation bag with 500 to 1,000 ml of lukewarm water
c. Stopping the irrigation for cramps and clamping the tubing until cramps pass
d. Washing hands with soap and water when finished
42. A client is receiving captopril for heart failure. The nurse should notify the physician that the medication therapy is ineffective
if an assessment reveals:
a. a skin rash. c. a dry cough.
b. peripheral edema. d. postural hypotension.
43. The nurse is preparing a client with systemic lupus erythematosus (SLE) for discharge. Which instruction should the nurse
include in the teaching plan?
a. Exposure to sunlight will help control skin rashes.
b. There are no activity limitations between flare-ups.
c. Monitor body temperature.
d. Corticosteroids may be stopped when symptoms are relieved.
44. A client is being discharged from the hospital after treatment for severe asthma. The nurse is teaching her about her
medications. Which point should the nurse include when teaching the client about salmeterol?
a. Use the inhaler for chest tightness.
b. Take two puffs every 4 hours.
c. It provides relief of nighttime asthma.
d. It's a corticosteroid and shouldn't be abruptly stopped.
45. The nurse administered NPH insulin to a client with diabetes at 7 a.m. At what time would the nurse expect the client to be
most at risk for a hypoglycemic reaction?
a. 10 a.m. b.Noon c. 4 p.m. d. 10 p.m.
46. A client tells the nurse that she has been working hard for the past 3 months to control her type 2 diabetes mellitus with diet
and exercise. To determine the effectiveness of the client's efforts, the nurse should check:
a. urine glucose level
b. fasting blood glucose level
c. serum fructosamine level
d. glycosylated hemoglobin level
47. The nurse is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse would
expect to find:
a. hypotension.
b. thick, coarse skin.
c. deposits of adipose tissue in the trunk and dorsocervical area.
d. weight gain in arms and legs.
48. An 89-year-old client is suffering from Alzheimer's-type dementia. Which intervention would be most useful in managing his
dementia?
a. Provide a safe environment.
b. Provide a stimulating environment.
c. Avoid the use of touch.
d. Use restraints whenever necessary.
49. The nurse must plan care for a 28-year-old female hospitalized with a diagnosis of myasthenia gravis. Which of the
following times would be most appropriate for procedures and care to be completed?
a. All at one time, to provide a longer rest period
b. Before meals, to stimulate her appetite
c. In the morning, with frequent rest periods
d. Before bedtime, to promote rest
50. A 37-year-old teacher is hospitalized with complaints of weakness, incoordination, dizziness, and loss of balance. The
diagnosis is multiple sclerosis (MS). Which of the following signs and symptoms, discovered during the history and physical
assessment, is typical of MS?
a. Diplopia, history of increased fatigue, and decreased or absent deep tendon reflexes

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b. Flexor spasm, clonus, and negative Babinski's reflex
c. Blurred vision, intention tremor, and urinary hesitancy
d. Hyperactive abdominal reflexes and history of unsteady gait and episodic paresthesia in both legs
51. A client is receiving a blood transfusion. If he experiences an acute hemolytic reaction, which nursing intervention is the
most important?
a. Immediately stop the transfusion, infuse dextrose 5% in water (D5W), and call the physician.
b. Slow the transfusion and monitor the client closely.
c. Stop the transfusion, notify the blood bank, and administer antihistamines.
d. Immediately stop the transfusion, infuse normal saline solution, notify the blood bank, and call the physician.
52. An 86-year-old male is hospitalized with an exacerbation of his heart failure. He's confused and has inadvertently pulled out
his I.V. catheters several times while attempting to get out of bed by himself. He was also found lying on the floor unharmed.
When all other methods fail to keep the client in bed, the physician orders the use of physical restraints. Which nursing
action reflects safe nursing care?
a. Remove restraints once a shift to check skin and circulation.
b. Cover the restraints with a blanket so that the client can't see them.
c. Apply restraints firmly so that a finger can't be inserted underneath them.
d. Tie the restraint to the bed frame.
53. A client with acute respiratory failure is intubated and placed on mechanical ventilation. Which intervention is most
appropriate when suctioning the client?
a. Insert the suction catheter while applying suction.
b. Apply suction until all the secretions have been removed.
c. Use the same catheter to first suction the mouth, then the endotracheal tube.
d. Preoxygenate with 100% oxygen before suctioning.
54. The nurse is providing care for a postoperative client who has undergone a small bowel resection. The nurse may use an
epidural catheter for which of the following?
a. Antibiotic therapy c. Blood transfusion
b. Pain management d. Anticoagulation
55. The nurse is caring for a wheelchair-bound client. Which piece of equipment impedes circulation to the area it's meant to
protect?
a. Polyurethane foam mattress c. Gel flotation pad
b. Ring or donut d. Water bed
56. The nurse is caring for a client with an endotracheal (ET) tube who receives enteral feedings through a feeding tube. Before
each tube feeding, the nurse checks for tube placement in the stomach as well as residual volume. The purpose of the
nurse's actions is to avoid:
a. gastric ulcers. c. abdominal distention.
b. aspiration. d. diarrhea.
57. The nurse is caring for a client who requires intracranial pressure (ICP) monitoring. The nurse should be alert for what
major complication of ICP monitoring?
a. Coma c. High blood pressure
b. Infection d. Apnea
58. The nurse is assisting during a lumbar puncture. How should the nurse position the client for this procedure?
a. Prone, with the head turned to the right
b. Supine, with the knees raised toward the chest
c. Lateral recumbent, with chin resting on flexed knees
d. Lateral, with right leg flexed
59. The nurse is performing a mental status examination on a client diagnosed with a subdural hematoma. This test assesses:
a. cerebellar function. c. cerebral function.
b. intellectual function. d. sensory function.
60. The nurse administers chemotherapeutic drugs to a client with cancer. What adverse effects are most common?
a. Painful mouth sores c. Nausea and vomiting
b. Frequent diarrhea d. Constipation
61. To combat the most common adverse effects of chemotherapy, the nurse would administer an:
a. antiemetic. c. tumor antibiotic.
b. antimetabolite. d. anticoagulant.
62. The nurse administers furosemide (Lasix) to treat a client with heart failure. Which adverse effect must the nurse watch for
most carefully?
a. Increase in blood pressure
b. Increase in blood volume
c. Low serum potassium level
d. High serum sodium level
63. A client with type 1 diabetes mellitus asks the nurse about taking an oral antidiabetic agent. The nurse explains that these
medications are only effective if the client:
a. prefers to take insulin orally.
b. has type 2 diabetes.
c. has type 1 diabetes.
d. is a pregnant, type 2 diabetic.
64. The nurse is teaching a client who receives nitrates for the relief of chest pain. Which of the following instructions should the
nurse emphasize?
a. Repeat the dose of sublingual nitroglycerin every 15 minutes for three doses.

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b. Store the drug in a cool, well-lit place.
c. Lie down or sit in a chair for 5 to 10 minutes after taking the drug.
d. Restrict alcohol intake to two drinks per day.
65. The nurse is administering total parenteral nutrition (TPN) to a client who underwent surgery for gastric cancer. What is a
major complication of TPN?
a. Hyperglycemia c. Hypotension
b. Extreme hunger d. Hypoglycemia
66. The nurse is teaching a client who has been prescribed allopurinol for the treatment of gout. Which instruction would the
nurse give to the client?
a. Increase alcohol intake while taking the drug.
b. Avoid foods that are rich in purine.
c. Take aspirin for pain.
d. Take the drug between meals to promote absorption.
67. The nurse is caring for a client with a postoperative wound evisceration. Which action should the nurse perform first?
a. Explain to the client what is happening and provide support.
b. Cover the protruding internal organs with sterile gauze moistened with sterile saline solution.
c. Push the protruding organs back into the abdominal cavity.
d. Ask the client to drink as much fluid as possible.
68. The nurse provides care for a client receiving oxygen from a nonrebreathing mask. Which nursing intervention has the
highest priority?
a. Posting a no smoking sign over the client's bed
b. Applying an oil-based lubricant to the client's mouth and nose
c. Assessing the client's respiratory status, orientation, and skin color
d. Changing the mask and tubing daily
69. The nurse prepares to perform postural drainage. How should the nurse ascertain the best position to facilitate clearing the
lungs?
a. Inspection c. Arterial blood gas (ABG) levels
b. X-ray d. Auscultation
70. To assess a client's cranial nerve function, the nurse should:
a. assess hand grip.
b. assess orientation to person, time, and place.
c. assess arm drifting.
d. assess gag reflex.
71. Which of the following clinical findings would the nurse look for in a client with chronic renal failure?
a. Hypotension c. Metabolic alkalosis
b. Uremia d. Polycythemia
72. The nurse observes constant bubbling in the water-seal chamber of a closed chest drainage system. What should the nurse
conclude?
a. The system is functioning normally.
b. The client has a pneumothorax.
c. The system has an air leak.
d. The chest tube is obstructed.
73. The nurse observes that decerebrate posturing is a comatose client's response to painful stimuli. The client exhibits
extended and pronated arms, flexed wrists with palms facing backward, and rigid legs extended with plantar flexion.
Decerebrate posturing as a response to pain indicates:
a. dysfunction in the cerebrum.
b. the risk of increased intracranial pressure (ICP).
c. dysfunction in the brain stem.
d. dysfunction in the spinal column.
74. What mechanical device increases coronary perfusion and cardiac output and decreases myocardial workload and oxygen
consumption in a client with cardiogenic shock?
a. Cardiac pacemaker
b. Hypothermia/hyperthermia machine
c. Defibrillator
d. Intra-aortic balloon pump
75. While monitoring a client for the development of disseminated intravascular coagulation (DIC), the nurse should take note of
what assessment parameters?
a. Platelet count, prothrombin time (PT), and partial thromboplastin time (PTT)
b. Platelet count, blood glucose levels, and white blood cell (WBC) count
c. Thrombin time, calcium levels, and potassium levels
d. Fibrinogen level, WBC count, and platelet count
76. The nurse is caring for a client diagnosed with a cerebral aneurysm who reports a severe headache. Which action should
the nurse perform?
a. Sit with the client for a few minutes.
b. Administer an analgesic.
c. Inform the nurse-manager.
d. Call the physician immediately.
77. A client who agreed to become an organ donor is pronounced dead. What is the most important factor in selecting a
transplant recipient?

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a. Blood relationship
b. Sex and size
c. Compatible blood and tissue types
d. Need
78. A client who has sustained a head injury is to receive mannitol (Osmitrol) by I.V. push. In evaluating the effectiveness of the
drug, the nurse should expect to find:
a. increased lung expansion
b. decreased cerebral edema
c. decreased cardiac workload
d. increased cerebral circulation
79. A client with a neurogenic bladder is beginning bladder training. Which of the following nursing actions is most important?
a. Set up specific times to empty the bladder.
b. Force fluids.
c. Provide adequate roughage.
d. Encourage the use of an indwelling urinary catheter.
80. Which intervention will best help to prevent a client from falling?
a. Monitor the client regularly or continually if his condition warrants it.
b. Keep the bed at a level where the nurse can easily provide care.
c. Make sure the side rails of the client's bed are down.
d. Restrain the client to prevent him from getting out of bed and falling.
81. The nurse is administering a purified protein derivative (PPD) test to a homeless client. Which of the following statements
concerning PPD testing is true?
a. A positive reaction indicates that the client has active tuberculosis (TB).
b. A positive reaction indicates that the client has been exposed to the disease.
c. A negative reaction always excludes the diagnosis of TB.
d. The PPD can be read within 12 hours after the injection.
82. A nurse working in a senior center encounters a client who recently lost his spouse as well as several friends and family
members. What is the best way for the nurse to assist the client?
a. Recommend that the client get over the loss and move on with his life.
b. Encourage the client to participate in grief counseling.
c. Suggest that the client move into a senior residence to avoid places that remind him of his wife.
d. Ignore the client's grief because it's only temporary.
83. The nurse is caring for a client with a reactive purified protein derivative (PPD) test. What should the nurse anticipate as the
next step of treatment?
a. Immediately begin administration of prophylactic medications to eradicate the disease.
b. Immediately isolate the client (for at least 1 week) to contain the disease.
c. Perform more definitive testing to determine whether the client has active disease.
d. Explain to the client that a positive PPD only indicates exposure to the disease and that he must be retested in 6
months.
84. The nurse is planning a group teaching session on the topic of urinary tract infection (UTI) prevention. Which point would
the nurse want to include?
a. Limit fluid intake to reduce the need to urinate.
b. Take medication prescribed for a UTI until the symptoms subside.
c. Notify the physician if urinary urgency, burning, frequency, or difficulty occurs.
d. Wear only nylon underwear to reduce the chance of irritation.
85. The nurse is teaching a female client about preventing osteoporosis. Which of the following teaching points is correct?
a. Obtaining an X-ray of the bones every 3 years is recommended to detect bone loss.
b. To avoid fractures, the client should avoid strenuous exercise.
c. The recommended daily allowance of calcium may be found in a wide variety of foods.
d. Obtaining the recommended daily allowance requires taking a calcium supplement.
86. The nurse is preparing a client with a malignant tumor for colorectal surgery and subsequent colostomy. The client tells the
nurse that he's anxious. What would the nurse's initial step be in working with this client?
a. Determining what the client already knows about colostomies
b. Showing the client pictures of colostomies
c. Arranging for someone who has had a colostomy to visit the client
d. Providing the client with written materials about colostomy care
87. A 42-year-old client, the mother of two children, has just been told that her ovarian cancer is terminal. The client, usually
religiously observant, is expressing rage at God and the clergy. The nurse makes the diagnosis of Spiritual distress related
to a situational crisis. Which intervention is appropriate for this client?
a. Engage the client in diversional activities to distract her from the present situation.
b. Help the client use effective coping strategies to ease spiritual discomfort.
c. Encourage the client to read everything possible about the treatment of ovarian cancer.
d. Allow the client time and space to bargain with God for a cure.
88. A client on long-term mechanical ventilation becomes very frustrated when he tries to communicate. Which of the following
interventions should the nurse perform to assist the client?
a. Assure the client that everything will be all right and that he shouldn't become upset.
b. Ask a family member to interpret what the client is trying to communicate.
c. Ask the physician to wean the client off of the mechanical ventilator to allow the client to talk.
d. Ask the client to write, use a picture board, or spell words with an alphabet board.

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89. Based on an assessment of a client's health and home environment, the nurse determines the need for assistive devices,
such as hearing aids, cane, walker, wheelchair, or shower chair. What is the purpose of providing assistive devices?
a. To help the client to remain independent and thereby improve self-confidence
b. To counter premature efforts to achieve independence by fostering the client's need for assistive devices
c. To determine whether the caregiver understands concepts of home safety by introducing more safety hazards into the
home
d. To relieve the caregiver of responsibility for the client
90. Following hospitalization for a fractured hip, a client is transferred to a nursing care center. The client is upset about not
being able to return home immediately. The nurse makes the diagnosis of Relocation stress syndrome. Which of these
interventions would most benefit this client?
a. Inviting the family to tour the facility and meet the new staff
b. Educating the family about relocation stress syndrome and the support that the client needs
c. Recommending that the family visit regularly
d. Encouraging the client to express emotions associated with relocation
91. Which of the following statements describing urinary incontinence in the elderly is true?
a. Urinary incontinence is a normal part of aging.
b. Urinary incontinence isn't a disease.
c. Urinary incontinence in the elderly can't be treated.
d. Urinary incontinence is a disease.
92. The nurse is changing a dressing and providing wound care. Which activity should she perform first?
a. Assess the drainage in the dressing.
b. Slowly remove the soiled dressing.
c. Wash hands thoroughly.
d. Put on latex gloves.
93. The nurse is teaching the client how to use a cane. Which of the following statements is most inaccurate?
a. The client should hold the cane on the involved side.
b. The client should hold the cane close to his body.
c. The stride length and the timing of each step should be equal.
d. The nurse should stand behind the client to prevent falls.
94. The nurse is giving instructions to family members of a client who can't feed himself. Which of the following should the
nurse recommend?
a. Keep the client on a soft food or liquid diet.
b. Ask the physician to order total parenteral nutrition (TPN) for the client.
c. Determine foods best handled by the client and feed these foods to him.
d. Have the physician order a gastrostomy tube for feeding the client.
95. An elderly client who underwent total hip replacement exhibits a red, painful area on the calf of the affected leg. What test
validates the presence of a thromboembolism?
a. Rhomberg c. Rinne
b. Phalen's d. Homans'
96. Laboratory studies indicate a client's blood sugar level is 185 mg/dl. Two hours have passed since the client ate breakfast.
Which test would yield the most conclusive diagnostic information about the client's glucose utilization?
a. A fasting blood sugar
b. A 6-hour glucose tolerance test
c. A test of serum glycosylated hemoglobin (Hb A1c)
d. A test for urine ketones
97. Every morning a client with type 1 diabetes receives 15 units of Humulin 70/30. What does this type of insulin contain?
a. 70 units of NPH insulin and 30 units of regular insulin
b. 70 units of regular insulin and 30 units of NPH insulin
c. 70% NPH insulin and 30% regular insulin
d. 70% regular insulin and 30% NPH insulin
98. The nurse is caring for a postthyroidectomy client at risk for hypocalcemia. What should the nurse do?
a. Monitor laboratory values daily for an elevated thyroid-stimulating hormone.
b. Observe for swelling of the neck, tracheal deviation, and severe pain.
c. Evaluate the quality of the client's voice postoperatively, noting any drastic changes.
d. Observe for muscle twitching and numbness or tingling of the lips, fingers, and toes.
99. To verify the placement of a gastric feeding tube, the nurse should perform at least two tests. One test requires instilling air
into the tube with a syringe and listening with a stethoscope for air passing into the stomach. What is another test method?
a. Aspiration of gastric contents and testing for a pH less than 6.0
b. Instillation of 30 ml of water while listening with a stethoscope
c. Cessation of reflex gagging
d. Ensuring proper measurement of the tube before insertion
100.A 25-year-old female client seeks care for a possible infection. Her symptoms include burning on urination and frequent,
urgent voiding of small amounts of urine. She's placed on trimethoprim-sulfamethoxazole (Bactrim) to treat possible
infection. Another medication is prescribed to decrease the pain and frequency. Which of the following is the most likely
medication prescribed?
a. Nitrofurantoin (Macrodantin)
b. Ibuprofen (Motrin)
c. Acetaminophen with codeine
d. Phenazopyridine (Pyridium)

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101.A female client has just been diagnosed with condylomata acuminata (genital warts). What information is appropriate to tell
this client?
a. This condition puts her at a higher risk for cervical cancer; therefore, she should have a Papanicolaou (Pap) test
annually.
b. The most common treatment is metronidazole (Flagyl), which should eradicate the problem within 7 to 10 days.
c. The potential for transmission to her sexual partner will be eliminated if condoms are used every time they have sexual
intercourse.
d. The human papillomavirus (HPV), which causes condylomata acuminata, can't be transmitted during oral sex.
102.A 35-year-old female client is requesting information about mammograms and breast cancer. She isn't considered at high
risk for breast cancer. What should the nurse tell this client?
a. She should have had a baseline mammogram before age 30.
b. She should eat a low-fat diet to further decrease her risk of breast cancer.
c. She should perform breast self-examinations (BSEs) during the first 5 days of each menstrual cycle.
d. When she begins having yearly mammograms, BSEs are no longer necessary.
103.The ABCD method offers one way to assess skin lesions for possible skin cancer. What does the A stand for?
a. Actinic c. Arcus
b. Asymmetry d. Assessment
104.What should a male client over age 50 do to help ensure early identification of prostate cancer?
a. Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly.
b. Have a transrectal ultrasound every 5 years.
c. Perform monthly testicular self-examinations, especially after age 50.
d. Have a complete blood count (CBC) yearly (including blood urea nitrogen [BUN] and creatinine assessment).
105.A client in a nursing home is diagnosed with Alzheimer's disease. He exhibits the following symptoms: difficulty with recent
and remote memory, irritability, depression, restlessness, difficulty swallowing, and occasional incontinence. This client is in
what stage of Alzheimer's disease?
a. I b.II c. III d. IV
106.A family member is caring for a client diagnosed with Alzheimer's disease. Which of the following is most likely to cause the
caregiver depression and role strain?
a. The caregiver had a close relationship with the client before diagnosis of the illness.
b. The caregiver has no formal support, such as a visiting nurse or day care worker.
c. The caregiver understands the full reality of the disease and its inevitable progression.
d. The caregiver feels unable to control the client and unable to cope with caregiving.
107.A client is hospitalized with a possible electrolyte imbalance. The client is disoriented and weak, has an irregular pulse, and
takes hydrochlorothiazide. The client most likely suffers from:
a. hypernatremia. c. hyperkalemia.
b. hyponatremia. d. hypokalemia.
108.An elderly client asks the nurse how to treat chronic constipation. What is the best recommendation the nurse can make?
a. Take a mild laxative, such as magnesium citrate, when necessary.
b. Take a stool softener, such as docusate sodium (Colace), daily.
c. Administer a tap water enema weekly.
d. Administer a phospho-soda (Fleets) enema when necessary.
109.The nurse is providing postoperative care for a client recovering from abdominal surgery. The client is receiving morphine
through a client-controlled analgesia pump. Which finding would indicate that the client is obtaining adequate pain relief?
a. Awakening several times during the night to redose
b. Respiratory rate of 10 breaths/minute
c. Pain rating of 2 or 3 on a scale of 0 to 10
d. Complaint of itching as an adverse effect of the analgesia
110. A peripherally placed needle for intermittent infusion of antibiotics is a potential site for infection. When assessing the
infusion site, the nurse should look for what signs?
a. Puffiness of the tissue below the tip of the needle and absence of blood return
b. A painful red line running down the arm along the course of the vein
c. A tender lump within the vein located close to the tip of the needle
d. Redness and drainage around the needle insertion site
111. A client who experienced a stroke and developed left-sided paralysis is learning how to dress independently. What is the
proper technique for upper extremity dressing?
a. Buttoning the shirt first then flipping it on over the head
b. Placing the unaffected arm in the shirt before the affected arm
c. Requesting help because this activity is impossible to do independently
d. Placing the affected arm in the shirt before the unaffected arm
112. A client taking aspirin for arthritis reports experiencing adverse effects. What adverse effect indicates that a decrease in
dose may be necessary?
a. Tinnitus
b. Mild gastric irritation
c. Mild bleeding of the gums when brushing teeth
d. Decrease in arthritic pain
113. A 64-year-old female is found on the floor of her apartment. She had apparently fallen and hit her head on the bathtub. On
admission to the neurologic unit, she has a decreased level of consciousness. The physician orders positioning as follows:
elevate the head of the bed; keep the head in neutral alignment with no neck flexion or head rotation; avoid sharp hip
flexion. Which of the following is the best rationale for this positioning?

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a. To decrease cerebral arterial pressure
b. To avoid impeding venous outflow
c. To prevent flexion contractures
d. To prevent aspiration of stomach contents
114. A 58-year-old male is hospitalized for a wedge resection of the left lower lung lobe. A routine chest X-ray shows carcinoma.
The client is anxious and asks if he can smoke. Which of the following statements by the nurse would be most therapeutic?
a. "Smoking is the reason you're here."
b. "The doctor left orders for you not to smoke."
c. "You're anxious about the surgery. Do you see smoking as helping?"
d. "Smoking is OK right now, but after your surgery it's contraindicated."
115. A female client is discharged from the hospital after having an episode of heart failure. She's prescribed daily oral doses of
digoxin (Lanoxin) and furosemide (Lasix). Two days later, she tells her community health nurse that she feels weak and
frequently feels her heart "flutter." What action should the nurse take?
a. Tell the client to rest more often.
b. Tell the client to stop taking the digoxin, and call the physician.
c. Call the physician, report the symptoms, and request to draw a blood sample to determine the client's potassium level.
d. Tell the client to avoid foods that contain caffeine.
116. A male client with a total hip replacement is progressing well and expects to be discharged tomorrow. On returning to bed
after ambulating, he complains of severe pain in the surgical wound. Which action should the nurse take?
a. Assume he's anxious about discharge, and administer pain medication.
b. Assess the surgical site and affected extremity.
c. Reassure the client that pain is a direct result of increased activity.
d. Suspect a wound infection, and monitor the client's temperature and vital signs.
117. The nurse brings a client his prescribed antibiotic. The client tells the nurse that he usually takes a white tablet, not the
yellow tablet in the medication cup. What should the nurse do?
a. Tell the client that the yellow tablet is probably from a different manufacturer.
b. Reassure the client that it's the correct medication.
c. Withhold the medication and notify the physician.
d. Recheck the medication name and strength.
118. A client comes to the emergency department with an acute myocardial infarction. An electrocardiogram shows a heart rate
of 116 beats/minute with frequent premature ventricular contractions. The client experiences ventricular tachycardia and
becomes unresponsive. After resuscitation, the client moves to the intensive care unit. Which nursing diagnosis is top
priority?
a. Impaired physical mobility related to complete bed rest
b. Deficient knowledge related to emergency interventions
c. Social isolation related to restricted family visits
d. Anxiety related to the threat of death
119. A 57-year-old client reports experiencing leg pain whenever he walks several blocks. The client has type 1 diabetes and has
smoked two packs of cigarettes per day for the past 40 years. The physician diagnoses intermittent claudication. The nurse
should provide which instruction about long-term care to the client?
a. Practice meticulous foot care.
b. Consider cutting down on your smoking.
c. Reduce your exercise level.
d. See the physician if the symptoms bother you.
120.The nurse is caring for a client with adult respiratory distress syndrome (ARDS). What is the most likely laboratory finding in
the early stages of this disease?
a. Increased carboxyhemoglobin
b. Decreased partial pressure of arterial oxygen (PaO2)
c. Increased partial pressure of arterial carbon dioxide (PaCO2)
d. Decreased bicarbonate (HCO3)
121.The nurse provides care for a client with chronic obstructive pulmonary disease (COPD). Administering high doses of
oxygen may produce what result?
a. Increased respiratory drive
b. Diminished respiratory drive
c. A mismatch between ventilation and perfusion
d. A profound decrease in partial pressure of arterial carbon dioxide (PaCO2)
122.Right-sided heart failure may develop as a result of pulmonary embolus. What is a hallmark sign of right-sided heart failure?
a. A physiologic second heart sound (S2) split
b. P pulmonale
c. Expiratory wheezing
d. Pericardial friction rub
123.Conjunctivitis may be caused by bacteria, viruses, allergens, or irritants. What signs and symptoms differentiate bacterial
conjunctivitis from other types?
a. Subacute onset, severe pain, and preauricular adenopathy
b. Recurrent onset, no pain, and clear discharge
c. Acute onset, moderate pain, and purulent discharge
d. Acute onset, mild pain, and clear discharge
124.What finding would lead the nurse to conclude that treatment for conjunctivitis wasn't effective?
a. The client's eye pain is relieved.

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b. Preauricular adenopathy is decreased.
c. Purulent discharge is resolved.
d. Both eyes have purulent discharge.
125.The nurse is caring for a client experiencing dyspnea, dependent edema, hepatomegaly, crackles, and jugular vein
distention. What condition should the nurse suspect?
a. Pulmonary embolism c. Cardiac tamponade
b. Heart failure d. Tension pneumothorax
126.A client arrives in the emergency department complaining of squeezing substernal pain that radiates to the left shoulder and
jaw. He also complains of nausea, diaphoresis, and shortness of breath. What should the nurse do?
a. Complete the client's registration information, perform an electrocardiogram, gain I.V. access, and take vital signs.
b. Alert the cardiac catheterization team, administer oxygen, attach a cardiac monitor, and notify the physician.
c. Gain I.V. access, give sublingual nitroglycerin, and alert the cardiac catheterization team.
d. Administer oxygen, attach a cardiac monitor, take vital signs, and administer sublingual nitroglycerin.
127.What does a positive Chvostek's sign indicate?
a. Hypocalcemia c. Hypokalemia
b. Hyponatremia d. Hypermagnesemia
128.The nurse is about to begin teaching a client how to perform tracheostomy care. What's the most important principle in
client teaching that the nurse needs to utilize?
a. Providing the most up-to-date information available
b. Alleviating the client's guilt associated with not knowing appropriate self-care
c. Determining the client's readiness to learn new information
d. Building on previous information
129.Which of the following teaching methods is most effective?
a. A list of instructions written at a sixth-grade level
b. A short videotape providing useful information and demonstrations
c. An audiotaped version of discharge instructions
d. A discussion and demonstration between the nurse and the client
130.A 49-year-old client is diagnosed with hypercholesterolemia. The client is obese. The nurse needs to determine if the client
has other major risk factors for coronary artery disease (CAD). Which factor would indicate an increased risk for CAD?
a. A history of diabetes mellitus
b. Elevated high-density lipoprotein (HDL) levels
c. A history of ischemic heart disease
d. A history of alcoholism
131.The nurse is planning care for a client with Mecre's disease. Which nursing diagnosis takes highest priority?
a. Acute pain related to Mnire's disease
b. Imbalanced nutrition: Less than body requirements related to nausea and vomiting
c. Risk for deficient fluid volume related to vomiting
d. Risk for injury related to vertigo
132.The nurse is transferring a client from the bed to a chair. What action should the nurse take during client transfer?
a. Help the client dangle his legs.
b. Position the head of the bed flat.
c. Stand behind the client.
d. Place the chair facing away from the bed.
133.The nurse is performing wound care. Which of the following practices violates surgical asepsis?
a. Holding sterile objects above the waist
b. Considering a 1 (2.5 cm) edge around the sterile field as being contaminated
c. Pouring solution onto a sterile field cloth
d. Opening the outermost flap of a sterile package away from the body
134.A 55-year-old male client has been diagnosed with open-angle glaucoma. The physician's orders include one drop of
pilocarpine (Pilocar) 1% in each eye every 6 hours. The client states that he doesn't understand the need for medication
because he doesn't have symptoms of an eye problem. Which of the following nursing diagnoses would be most
appropriate?
a. Noncompliance related to refusal to use eyedrops
b. Deficient knowledge related to the disease
c. Anxiety related to a new health problem
d. Disturbed body image related to the need for medication
135.The nurse is caring for a client with burns on his legs. Which nursing intervention will help to prevent contractures?
a. Applying knee splints
b. Elevating the foot of the bed
c. Hyperextending the client's palms
d. Performing shoulder range-of-motion (ROM) exercises
136.The nurse is caring for a client who had a stroke. Which nursing intervention promotes urinary continence?
a. Encouraging intake of at least 2 qt (2 L) of fluid daily
b. Giving the client a glass of soda before bedtime
c. Taking the client to the bathroom twice per day
d. Consulting with a dietitian
137.The nurse is caring for a client who just underwent a colectomy. What should the nurse do to prevent postoperative
thrombus formation in the legs?
a. Encourage the client to dorsiflex and plantar flex the feet.

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b. Instruct the client to turn from side to side every hour.
c. Have the client use a trapeze bar to move in bed.
d. Keep the client flat and warm.
138.The nurse is providing postoperative care for a client who has had spinal anesthesia. The nurse should place the client in
which position?
a. On the right side with two pillows under the head
b. On the left side in Sims' position
c. Supine with a pillow for comfort
d. Prone with no pillows
139.A client injured during a car accident is brought to the emergency department by ambulance. Which finding indicates that
the client sustained a head injury?
a. Tachycardia c. Hypotension
b. Widening pulse pressure d. Rapid respiratory rate
140.A male client who had a segmental left lung resection for treatment of a lung carcinoma returns from surgery with a left
posterior-lateral chest tube attached to a disposable water-seal chest drainage system. Which of the following signs would
indicate that the drainage system is working properly?
a. Air is bubbling in the water-seal chamber.
b. The fluid level in the drainage chamber remains constant.
c. The fluid level in the water-seal chamber fluctuates.
d. A pneumothorax is present.
141.The nurse is planning care for a 52-year-old male client experiencing an acute addisonian crisis. Which nursing diagnosis
should receive the highest priority?
a. Risk for infection
b. Decreased cardiac output
c. Impaired physical mobility
d. Imbalanced nutrition: Less than body requirements
142.The nurse is caring for a client experiencing acute addisonian crisis. Which laboratory data would the nurse expect to find?
a. Hyperkalemia
b. Reduced blood urea nitrogen (BUN)
c. Hypernatremia
d. Hyperglycemia
143.The nursing care for the client in addisonian crisis should include which of the following interventions?
a. Encouraging independence with activities of daily living (ADLs)
b. Allowing ambulation as tolerated
c. Offering extra blankets and raising the heat in the room to keep the client warm
d. Placing the client in a private room
144.The nurse is performing a dressing change for a client with a red, granulating foot ulcer. Which of the following actions is
part of this procedure?
a. Cleaning the wound with normal saline solution
b. Fully cleaning the ulcer vigorously
c. Applying a dry gauze dressing
d. Performing wet-to-dry dressing changes
145.The nurse is caring for a client with diabetes mellitus. When teaching the client about foot care, which instruction should the
nurse provide?
a. Examine feet once per week for redness, blisters, and abrasions.
b. Apply lotion to dry feet, especially between the toes.
c. Avoid hot-water bottles and heating pads.
d. Dry feet vigorously after each bath.
146.The nurse is assessing a client with hyperthyroidism. What findings should the nurse expect?
a. Weight gain, constipation, lethargy
b. Weight loss, nervousness, tachycardia
c. Exophthalmos, diarrhea, cold intolerance
d. Diaphoresis, fever, decreased sweating
147.The nurse is assessing a client after a thyroidectomy. The assessment reveals muscle twitching and tingling, along with
numbness in the fingers, toes, and mouth area. The nurse should suspect what complication?
a. Tetany c. Thyroid storm
b. Hemorrhage d. Laryngeal nerve damage
148.The nurse is caring for a client with cholecystitis receiving 1,000 ml of I.V. fluids infused over 12 hours. The administration
set delivers 15 gtt/ml. What should the drip rate be?
a. 15 gtt/minute c. 67 gtt/minute
b. 21 gtt/minute d. 84 gtt/minutes
149.The nurse is caring for a client with cholelithiasis. Which sign indicates obstructive jaundice?
a. Straw-colored urine c. Clay-colored stools
b. Reduced hematocrit d. Elevated urobilinogen in the urine
150.The nurse is caring for a client undergoing a cystoscopy to diagnose bladder cancer. Following the test, the client returns to
his room. Which signs should alert the nurse to a potential complication?
a. Chills and tachycardia
b. Urinary frequency and burning on urination
c. Dizziness and fainting

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d. Pink-tinged urine and bladder spasms
151.A client with bladder cancer undergoes a total cystectomy and ileal conduit. Postoperatively, the nurse notes mucus in the
client's urine. Which nursing intervention is most appropriate?
a. Informing the physician that the client has a urinary tract infection
b. Obtaining a urine specimen for culture and sensitivity
c. Monitoring for other signs and symptoms of infection
d. Explaining to the client that this is normal after this type of surgery
152.A client with hyperthyroidism is started on propylthiouracil. When should the nurse expect noticeable improvement in the
client's condition?
a. In 24 to 48 hours c. In 2 to 4 weeks
b. In 6 to 7 days d. In 6 months
153.A client with pneumothorax asks, Why did they put tubes on my chest? The nurse should explain that the purpose of the
chest tube is to:
a. Check the bleeding in the lung
b. Monitor the function of the lung
c. Drain fluid from the pleural space
d. Remove air from the pleural space
154.When inspecting a dressing following a partial pneumonectomy for cancer of the lung, the nurse observes some puffiness
of the tissue around the area. When the area is palpated, the tissue feels spongy and crackles. When charting, the nurse
should describe this as:
a. Stridor c. Pitting edema
b. Crepitus d. Chest distention
155.When turning a client following right pneumonectomy, the nurse should plan to place the client in either the:
a. Right or left side lying position
b. High fowlers or supine position
c. Supine or right side lying position
d. Left side lying position or low fowlers position
156.After thoracentesis for pleural effusion, a client returns to the physicians office for a follow up visit. The nurse would suspect
a recurrence of pleural effusion when the client says:
a. Lately I can only breathe well when I sit up
b. During the night I sometimes have fever and chills
c. I get a sharp stabbing pain when I take deep breath
d. I am coughing up larger amounts of thicker mucus for the last two days
157.During the immediate post op period after laryngectomy, a nursing priority for the client should be to:
a. Provide emotional support
b. Observe for signs of infection
c. Keep the trachea free of secretions
d. Promote a means of communication
158.Chronic Bronchial asthma will result to:
a. Respiratory alkalosis c. Metabolic Alkalosis b. Respiratory acidosis d. Metabolic
acidosis
159.After surgery, the physician orders an incentive spirometer for a client. The nurse would know that the client was using the
spirometer correctly when observing that the client:
a. Uses the incentive spirometer for 10 consecutive breaths an hour
b. Coughs twice before inhaling deeply through the mouth piece
c. Inhales deeply, seals the lips around the mouthpiece and exhales
d. Inhales deeply through the mouthpiece hold breath for 2seconds then exhales
160.A 60 year old male is returned to the surgical unit after laryngoscopy. The nurse reminds the client not to take anything by
mouth until instructed to do so. This nursing intervention generally would be considered:
a. Appropriate because these clients usually experience painful swallowing for several days
b. Appropriate because early drinking or eating after the clients laryngoscopy may result in aspiration
c. Inappropriate because the client is not unconscious and maybe thirsty after being NPO
d. Inappropriate because the client is likely to be anxious and probably will not be aware of feeling thirsty
161.A total laryngectomy and radical neck dissection is scheduled for client with cancer of the larynx. When reinforcing the
physicians statements to the client, the nurse should review what the surgery entails and what abilities will be lost. The
discussion also should focus on what abilities will be retained, such as the ability to:
a.Blow the nose c. Chew and swallow food
b.Sip through the straw d. Smell and differentiate odors
162.A client is receiving an antihypertensive drug IV for control of severe hypertension. The clients BP is unstable and at 160/94
before the infusion. Fifteen minutes after the infusion is started the blood pressure rises to 180/100. The response to the
drug would be describe as:
a.Allergic response c. Paradoxical response
b.Synergistic response d. Individual hypersusceptibility
163.Evaluation of effectiveness of Nitroglycerine SL is based on
a. Relief of anginal pain
b. Improve cardiac output
c. A decreased in blood pressure
d. Dilation of superficial vessel

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164.A client is receiving an anticoagulant for pulmonary embolism. The drug that is contraindicated for clients receiving
anticoagulant is:
a. Chloral hydrate c. Isoxsuprine ( Vasodilan )
b. Acetylsalicylic acid d. Chlorpromazine (Thorazine )
165.Early symptoms of Morphine overdose include:
a.Slow pulse, slow respiration and sedation
b.Slow respirations, dilated pupils and deep sleep
c.Profuse sweating, pinpoint pupils and deep sleep
d.Slow respiration, constricted pupils and deep sleep
166.A nurse is taking care of the elderly with COPD in the home care. To prevent occurrence of pneumonia, the nurse would
include which of the following in her plan of care?
a.Instruct and observe the patient of thorough hand washing
b.Administering vaccines as ordered
c.Prevent patients to talk with one another for more than an hour
d.All of the above
167.The most definitive diagnostic test for Iron deficiency anemia is:
a.CBC c. Schillings test
b.Bone marrow aspiration d. Hematocrit
168.Elderly people have a high incidence of hip fracture because of:
a.Carelessness c. Sedentary existence
b.Fragility of the bones d. Rheumatoid diseases
169.The nurse would expect an elderly client with hearing loss caused by aging to have:
a.Copious, moist cerumen
b.Tears in the tympanic membrane
c.Difficulty hearing womens voices
d.Overgrowth of the epithelial auditory lining
170.The test that should be included in the yearly physical examination of men during the late middle and older adult year is:
a.PSA c. Triglycerides
b.ELISA for HIV d. Rheumatoid factor
171.A client with a history of hypertension is hospitalized with a Transient Ischemic Attacks (TIA). The client has been told to
stop smoking. The nurse discovers a pack of cigarettes in the clients bathrobe. The best course of action to take at this
time is to:
a.Let the client know where they found
b.Discard them without making a comment
c.Report the situation to the head nurse
d.Call the physician and request directions
172.A nurse administers an intravenous solution of 0.45% sodium chloride. With respect to human blood cells, this solution is:
a.Isotonic b.Isomeric c.Hypotonic d.Hypertonic
173.The statement that correctly compares the blood plasma & interstitial fluid is:
a.Both contain the same kind of ions
b.Plasma exerts lower osmotic pressure than does interstitial
c.Plasma contains slightly more of each kind of ions than does interstitial cells
d.The main cation in plasma is sodium, whereas the main cation in interstitial fluid is potassium
174.Ammonia is excreted by the kidney to help maintain:
a.Osmotic pressure of the blood
b.Acid- Base balance of the body
c.Low bacterial levels in the urine
d.Normal red blood cell production
175.The nurse understands that a client with albuminuria has edema caused by:
a.Fall in tissue hydrostatic pressure
b.Rise in plasma hydrostatic pressure
c.Fall in plasma colloid osmotic pressure
d.Rise in tissue colloid osmotic pressure
176.The nurse administers serum albumin to client to assist in:
a. a. Clotting of blood c. Activation of WBC
b. b. Formation of RBC d. Development of oncotic pressure
177.Which assessment finding is most likely in a patient with Myasthenia gravis?
a. Restlessness, decrease level of consciousness and history of extreme muscle weakness in the morning
b. Unequal papillary response, diplopia and inability to hold her mouth closed
c. Frequent changes in facial expression, exophthalmos and low pitched voice
d. Ptosis, dysphagia and nasal voice
178.The patient above was scheduled for peripheral iridectomy. The primary purpose of this procedure is to:
a. Prevent blood from entering the anterior chamber of the eye
b. Decrease the production of aqueous humor
c. Enhance drainage of aqueous humor
d. Permit papillary dilation
179.Once admitted, the physician indicates the patient is paraplegic. The family asks the nurse what this means. The nurse
explains that:
a.Upper extremities are paralyzed

14
b.Lower extremities are paralyzed
c. One side of the body is paralyzed
d.Both upper and lower extremities are paralyzed
180.A 25-year-old male suffered a spinal cord injury from playing basketball resulting in paraplegia. The nurse finds the patient
conscious, breathing satisfactorily and lying on his back complain of pain and an inability to move his legs. The nurse
recognizes that one major early problem of the patient is:
a.Hyper reflexia c. Hypotension
b.Muscle spasm d. Autonomic dysreflexia
181.The patient was diagnosed to have hyperopia. You expect that the patients condition is due to
a.A long eyeball c. Abnormal curvature of the cornea
b.A short eyeball d. Inability of the lens to accommodate
182.The above condition can be treated with:
a. Concave lens c. Cylindrical lens
b. Convex lens d. Double vision lens
183.The patient was diagnosed to have Huntingtons disease. Her daughter is asking you if she would get the same disease
later in her life. Knowing the transmission of the disease, your best response would be:
a.You better ask your doctor
b.You dont need to worry because you may not carry the gene
c. You have 25% chance of getting the disease
d.You have 50% chance of getting the disease
184.Manifestations of Huntingtons, include the following, except:
a.Movement problem c. Emotional disturbances
b.Intellectual dysfunction d. Rigidity and tremor
185.Cataract results from:
a.Destruction of the lens
b.Drying up of the lens fiber & crystallization
c. Corneal and scleral damage
d.Retinal detachment
186.On a visit to a clinic, a client reports the onset of early symptoms of rheumatoid arthritis. Which of the following would the
nurse most likely assess?
a.Early morning stiffness c. Deformed motion of joints
b. Limited motion of joints d. Rheumatoid nodules
187.The patient with renal failure will manifest all of the following, except:
a. Anemia b. Hypertension c. Hypokalemia d.No exception
188.Cushings disease resulted from high levels of glucocorticoids due to:
a. Hyperfunctioning of the adrenal glands
b.Hypersecretion of the pituitary gland or a tumor of ACTH
c.Overdose of exogenous steroids
d.Maybe all of the above
189.The patient is admitted with a diagnosis of Graves disease. You know that this patient would most likely manifest which of
the following signs?
a.Toxic goiter and increased TSH
b.Thyrotoxicosis & enlarged thyroid gland
c.Exopthalmos & cold intolerance
d.Elevated T3, T4 and calcitonin
190.The patient underwent thyroidectomy for thyroid cancer, you are aware of possible complications, which of the following is
not a complication of thyroidectomy:
a.Difficulty of breathing c. Hypoparathyroidism
b.Hoarseness d. Hypocalcemia & paralysis
191.The patient is undergoing hemodialysis because of chronic renal failure. You are asked by the relative on the chances of
recovery for this patient, based on your knowledge, your best response would be:
a.The patient has few months to live
b.He has to be maintained on hemodialysis or else he will die
c.He has to undergo hemodialysis to excrete his waste because the kidneys are not functioning
d.A kidney transplant can improve his condition
192.Upper urinary tract infection would most likely manifests the following signs & symptoms, except:
a.Flank pain b. Fever & chills c. Hematuria d. Dysuria
193.The initial manifestation of renal failure is
a.Hypovolemia b. Oliguria c.Nocturia d.Polyuria
194.A client is admitted after vomiting fresh blood. He is diagnosed to have duodenal ulcer. The client develops sudden, sharp
pain in the mid epigastric region along with a rigid boardlike abdomen. These clinical manifestations most likely indicate which
of the following?
a.An intestinal obstruction has developed
b.Additional ulcers develop
c.The esophagus has inflamed
d.The ulcer has perforated
195.A client is taking an antacid for treatment of PUD, Which of the following statements indicate that the client understands
how to correctly take the antacid?
a.I should take the antacid before my other medications

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b.I need to decrease my intake of fluid so that I dont dilute effects of my antacids
c.My antacid will be most effective if I take it whenever I have pain
d.It is best for me to take antacid 1 3 hours after meals
196.Patient was diagnosed to have hiatal hernia. What is the problem in herniation?
a.Protrusion of a part due to muscle weakness
b.Reflux esophagitis
c.Small meal is advise
d.All of the above
197.The nurse is aware that nutritional support of a clients natural defense mechanism would indicate a the need for a diet high
in:
a. The essential fatty acids
b. Dietary cellulose and fiber
c. The amino acid, tryptophan
d. Vitamins A, C & E and Selenium
198.Twelve hours after a female is admitted to the critical care unit following a motorcycle injury, she begins to complain of
increased abdominal pain in the left upper quadrant. A ruptured spleen is diagnosed, and she is scheduled for emergency
splenectomy. When preparing the client for surgery, the nurse should emphasize the:
a. Complete safety of the procedure
b. Expectation of post op bleeding
c. Risk of the procedure with other injuries
d. Presence of abdominal drainage for several days after surgery
199.A client is brought to the emergency service after an automobile accident. The clients BP is 100/60mmHg. And the physical
assessment suggests a ruptured spleen. Based on this information, the nurse should assess the client for an early sing of
decreased arterial pressure such as:
a. Warm, flushed skin c. Increased pulse pressure
b. Confusion and lethargy d. Reduced peripheral pulses
200.When a client is experiencing hypovolemic shock with decreased tissue perfusion, the nurse recognizes the body initially
attempts to compensate by:
a. Producing less ADH
b. Producing more RBC
c. Maintaining peripheral vasoconstriction
d. Decreasing mineralocorticoid secretion
201.A client has emergency surgery for a ruptured appendix. After assessing that the client is manifesting the symptoms of
shock, the nurse should:
a. Prepare for blood transfusion
b. Notify the physician immediately
c. evate the head of the bed 30 degrees
d. crease the liter flow of the O2 being administered
202.During the progressive stage of shock, anaerobic metabolism occurs, The nurse must be aware that initially this causes:
a..tabolic acidosis c. iratory acidosis
b. abolic alkalosis d. Respiratory alkalosis
203.A Client who is in hypovolemic shock has hematocrit value of 25%. The nurse should anticipate that the physician will order:
a. Ringers Lactate c. Blood replacement
b. Serum albumin d. High molecule dextran
204.Polycythemia is frequently associated with Chronic Obstructive Pulmonary Disease (COPD). When assessing for this
complication, the nurse should observe for:
a. Pallor and cyanosis c. A decreased hematocrit
b. Dyspnea on exertion d. An elevated hemoglobin
205.A male client with chronic liver disease reports that his gums bleed spontaneously. An addition, the nurse notes small
hemorrhagic lesions on his face. The nurse recognizes that the client needs additional:
a.Bile salts b.Folic acid c. Vitamin A d. Vitamin K
206.A Schillings Test is ordered for client who is suspected of having pernicious anemia. The nurse recognizes that the primary
purpose of this test is to determine the clients ability to:
a.Store Vitamin B12c. Absorb Vitamin B12
b.Digest Vitamin B12 d. Produce Vitamin B12
207..When discussing the therapeutic regimen of Vitamin B12, for pernicious anemia with a client, the nurse should explain that:
a. Weekly Z track injections provide weekly control
b. Daily IM injections are required for control
c. IM injection monthly will maintain control
d. Oral tablets of Vitamin B12 daily will control the symptoms
208.A client receiving Cyclophosphamide (Cytoxan) and a steroid (Prednisone) has white blood cell count of 12,000/cumm. And
red blood cell count of 4.2M/cumm. The instructions should receive the priority by the nurse would be:
a. Omit daily dose of prednisone
b. Avoid large crowds and persons with infections
c. Shave with electric rather than safety razor
d. Increase the intake of high protein foods and red meats
209.The nurse is aware that a client is receiving Azathioprine (Imuran ) Cyclosporine and Prednisone before a kidney transplant
surgery to:
a. Stimulate leukocytosis c. Prevent iatrogenic infections

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b. Provide passive immunity d. Reduce antibody production
210.When obtaining the history of a 24 year old graduate student recently diagnosed with type 1 DM, the nurse would expect to
identify the presence of:
a. Edema c. Weight loss
b. Anorexia d. Hypoglycemic episodes
211. A client with cancer of the thyroid gland is scheduled for thyroidectomy. Postoperatively, the nurse should plan to have:
a. A tracheostomy set at clients bedside
b. A quiet, dimly lit room ready for the client
c. A large soft pillow under the clients head
d. An intermittent suction apparatus at the clients bedside
212.A female client is admitted with a diagnosis of acute renal failure. She is awake, alert, oriented, and complaining of
severe back pain, nausea and vomiting and abdominal cramps. Her vital signs are blood pressure 100/70 mm Hg, pulse
110, respirations 30, and oral temperature 100.4F (38C). Her electrolytes are sodium 120 mEq/L, potassium 5.2 mEq/L;
her urinary output for the first 8 hours is 50 ml. The client is displaying signs of which electrolyte imbalance?
a. Hyponatremia c. Hyperphosphatemia
b. Hyperkalemia d. Hypercalcemia
213.Assessing the laboratory findings, which result would the nurse most likely expect to find in a client with chronic renal
failure?
a. BUN 10 to 30 mg/dl, potassium 4.0 mEq/L, creatinine 0.5 to 1.5 mg/dl
b. Decreased serum calcium, blood pH 7.2, potassium 6.5 mEq/L
c. BUN 15 mg/dl, increased serum calcium, creatinine l.0 mg/dl
d. BUN 35 to 40 mg/dl, potassium 3.5 mEq/L, pH 7.35, decreased serum calcium
214.Treatment with hemodialysis is ordered for a client and an external shunt is created. Which nursing action would be of
highest priority with regard to the external shunt?
a. Heparinize it daily
b. Avoid taking blood pressure measurements or blood samples from the affected arm
c. Change the Silastic tube daily
d. Instruct the client not to use the affected arm
215.Mark, age 78, is admitted to the hospital with the diagnosis of benign prostatic hyperplasia (BPH). He is scheduled for
a transurethral resection of the prostate (TURP). It would be inappropriate to include which of the following points in the
preoperative teaching?
a. TURP is the most common operation for BPH
b. Explain the purpose and function of a two-way irrigation system
c. Expect bloody urine, which will clear as healing takes place.
d. He will be pain free
216.Jarel is admitted to the hospital with a possible diagnosis of appendicitis. On physical examination, the nurse should be
looking for tenderness on palpation at McBurneys point, which is located in the:
a. left lower quadrant c. right lower quadrant
b. left upper quadrant d. right upper quadrant
217.Mr. Azarcon has undergone surgical repair of his inguinal hernia. Discharge teaching should include:
a. telling him to avoid heavy lifting for 4 to 6 weeks
b. instructing him to have a soft bland diet for two weeks
c. telling him to resume his previous daily activities without limitations
d. recommending him to drink eight glasses of water daily
218.A 30-year-old homemaker fell asleep while smoking a cigarette. She sustained severe burns of the face,neck, anterior
chest, and both arms and hands. Using the rule of nines, which is the best estimate of total body-surface area burned?
a. 18% b. 22% c. 31% d. 40%
219.Nursing care planning is based on the knowledge that the first 24-48 hours post-burn are characterized by:
a. An increase in the total volume of intracranial plasma
b. Excessive renal perfusion with diuresis
c. Fluid shift from interstitial space
d. Fluid shift from intravascular space to the interstitial space
220.If a client has severe bums on the upper torso, which item would be a primary concern?
a. Debriding and covering the wounds
b. Administering antibiotics
c. Frequently observing for hoarseness, stridor, and dyspnea
d. Establishing a patent IV line for fluid replacement
221.Contractures are among the most serious long-term complications of severe burns. If a burn is located on the upper torso,
which nursing measure would be least effective to help prevent contractures?
a. Changing the location of the bed or the TV set, or both, daily
b. Encouraging the client to chew gum and blow up balloons
c. Avoiding the use of a pillow for sleep, or placing the head in a position of hyperextension
d. Helping the client to rest in the position of maximal comfort
222.An adult is receiving Total Parenteral Nutrition (TPN). Which of the following assessment is essential?
a. evaluation of the peripheral IV site
b. confirmation that the tube is in the stomach
c. assess the bowel sound
d. fluid and electrolyte monitoring
223.Which drug would be least effective in lowering a clients serum potassium level?

17
a. Glucose and insulin c. Calcium glucomite
b. Polystyrene sulfonate (Kayexalate) d. Aluminum hydroxide
224.Maria refuses to acknowledge that her breast was removed. She believes that her breast is intact under the dressing. The
nurse should:
a. call the MD to change the dressing so Kathy can see the incision
b. recognize that Kathy is experiencing denial, a normal stage of the grieving process
c. reinforce Kathys belief for several days until her body can adjust to stress of surgery
d. remind Kathy that she needs to accept her diagnosis so that she can begin rehabilitation exercises
225.A chemotherapeutic agent 5FU is ordered as an adjunct measure to surgery. Which of the ff. statements about
chemotherapy is true?
a. it is a local treatment affecting only tumor cells
b. it affects both normal and tumor cells
c. it has been proven as a complete cure for cancer
d. it is often used as a palliative measure
226.Which is an incorrect statement pertaining to the following procedures for cancer diagnostics?
a. Biopsy is the removal of suspicious tissue and the only definitive method to diagnose cancer
b. Ultrasonography detects tissue density changes difficult to observe by X-ray via sound waves
c. CTscanning uses magnetic fields and radio frequencies to provide cross-sectional view of tumor
d. Endoscopy provides direct view of a body cavity to detect abnormality
227.A post-operative complication of mastectomy is lymphedema. This can be prevented by:
a. ensuring patency of wound drainage tube
b. placing the arm on the affected side in a dependent position
c. restricting movement of the affected arm
d. frequently elevating the arm of the affected side above the level of the heart
228.Which statement by the client indicates to the nurse that the patient understands precautions necessary during internal
radiation therapy for cancer of the cervix?
a. I should get out of bed and walk around in my room.
b. My 7 year old twins should not come to visit me while Im receiving treatment.
c. I will try not to cough, because the force might make me expel the application.
d. I know that my primary nurse has to wear one of those badges like the people in the x-ray department, but they are not
necessary for anyone else who comes in here.
229.High uric acid levels may develop in clients who are receiving chemotherapy. This is caused by:
a. The inability of the kidneys to excrete the drug metabolites
b. Rapid cell catabolism
c. Toxic effect of the antibiotic that are given concurrently
d. The altered blood ph from the acid medium of the drugs
230.Which of the following interventions would be included in the care of plan in a client with cervical implant?
a. Frequent ambulation c. Low residue diet
b. Unlimited visitors d. Vaginal irrigation every shift
231.Which nursing measure would avoid constriction on the affected arm immediately after mastectomy?
a. Avoid BP measurement and constricting clothing on the affected arm
b. Active range of motion exercises of the arms once a day
c. Discourage feeding, washing or combing with the affected arm
d. Place the affected arm in a dependent position, below the level of the heart
232.A client suffering from acute renal failure has an unexpected increase in urinary output to 150ml/hr. The nurse assesses that
the client has entered the second phase of acute renal failure. Nursing actions throughout this phase include observation for
signs and symptoms of:
a. Hypervolemia, hypokalemia, and hypernatremia
b. Hypervolemia, hyperkalemia, and hypernatremia
c. Hypovolemia, wide fluctuations in serum sodium and potassium levels
d. Hypovolemia, no fluctuation in serum sodium and potassium levels
233.An adult has just been brought in by ambulance after a motor vehicle accident. When assessing the client, the nurse would
expect which of the following manifestations could have resulted from sympathetic nervous system stimulation?
a. A rapid pulse and increased RR
b. Decreased physiologic functioning
c. Rigid posture and altered perceptual focus
d. Increased awareness and attention
234.Ms. Geronimo undergoes surgery and the abdominal aortic aneurysm is resected and replaced with a graft. When she
arrives in the RR she is still in shock. The nurses priority should be:
a. placing her in a trendeleburg position
b. putting several warm blankets on her
c. monitoring her hourly urine output
d. assessing her VS especially her RR
235.A major goal for the client during the first 48 hours after a severe bum is to prevent hypovolemic shock. The best indicator of
adequate fluid balance during this period is:
a. Elevated hematocrit levels
b. Urine output of 30 to 50 ml/hr
c. Change in level of consciousness
d. Estimate of fluid loss through the burn eschar

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236.A thoracentesis is performed on a chest-injured client, and no fluid or air is found. Blood and fluids is administered
intravenously (IV), but the clients vital signs do not improve. A central venous pressure line is inserted, and the initial
reading is 20 cm H^O. The most likely cause of these findings is which of the following?
a. Spontaneous pneumothorax c. Hemothorax
b. Ruptured diaphragm d. Pericardial tamponade
237.Intervention for a pt. who has swallowed a Muriatic Acid includes all of the following except:
a. administering an irritant that will stimulate vomiting
b. aspirating secretions from the pharynx if respirations are affected
c. neutralizing the chemical
d. washing the esophagus with large volumes of water via gastric lavage
238.Which initial nursing assessment finding would best indicate that a client has been successfully resuscitated after a cardio-
respiratory arrest?
a. Skin warm and dry
b. Pupils equal and react to light
c. Palpable carotid pulse
d. Positive Babinskis reflex
239.Chemical burn of the eye are treated with:
a. local anesthetics and antibacterial drops for 24 36 hrs.
b. hot compresses applied at 15-minute intervals
c. Flushing of the lids, conjunctiva and cornea with tap or preferably sterile water
d. cleansing the conjunctiva with a small cotton-tipped applicator
240.An emergency treatment for an acute asthmatic attack is Adrenaline 1:1000 given hypodermically. This is given to:
a. increase BP
b. decrease mucosal swelling
c. relax the bronchial smooth muscle
d. decrease bronchial secretions
241.Which of the following activities is not encouraged in a patient after an eye surgery?
a. sneezing, coughing and blowing the nose
b. straining to have a bowel movement
c. wearing tight shirt collars
d. sexual intercourse
242.A client who had undergone Billroth II procedure asks the nurse Why m I being given Vitamin B12 injection? The nurse
responds correctly by stating that
a. Vitamin B 12 is needed for absorption of Intrinsic factor that you are not producing since you lost your stomach in the
procedure
b. Vitamin B12 is needed for maturation of RBC
c. Since you lost your stomach in the procedure, you cannot absorb Vitamin B12, a supplement is needed for neural and
hematologic functions
d. Vitamin B 12 injection is needed to supplement your oral vitamin B 12
243.A client diagnosed with cerebral thrombosis is scheduled for cerebral angiography. Nursing care of the client includes the
following EXCEPT:
a. Inform the client that a warm, flushed feeling and a salty taste may be experienced
b. Maintain pressure dressing over the site of puncture
c. Check pulse, color and temperature of the extremity distal to the site of puncture
d. Kept the extremity used as puncture site flexed to prevent bleeding
244.Which is considered as the earliest sign of increased ICP that the nurse should closely observed for?
a. abnormal respiratory pattern
b. rising systolic and widening pulse pressure
c. contralateral hemiparesis and ipsilateral dilation of the pupils
d. progression from restlessness to confusion and disorientation to lethargy
245.Which is irrelevant in the pharmacologic management of a client with CVA?
a. Osmotic diuretics and corticosteroids are given to decrease cerebral edema
b. Anticonvulsants are given to prevent seizures
c. Thrombolytics are most useful within three hours of an occlusive CVA
d. Aspirin is used in the acute management of a completed stroke
246.What would be the MOST therapeutic nursing action when a clients expressive aphasia is severe?
a. Anticipate the client wishes so she will not need to talk
b. Communicate by means of questions that can be answered by the client shaking the head
c. Keep us a steady flow rank to minimize silence
d. Encourage the client to speak at every possible opportunity
247.The client has clear drainage from the nose and ears after a head injury. How can the nurse determine if the drainage is
CSF?
a. Measure the ph of the fluid c. Test for glucose
b. Measure the specific gravity of the fluid d. Test for chlorides
248.The nurse includes the important measures for stump care in the teaching plan for a client with an amputation. Which
measure would be excluded from the teaching plan?
a. Wash, dry, and inspect the stump daily
b. Treat superficial abrasions and blisters promptly

19
c. Apply a "shrinker" bandage with tighter arms around the proximal end of the affected limb
d. Toughen the stump by pushing it against a progressively harder substance (e.g., pillow on a foot-stool)
249.A 70-year-old female comes to the clinic for a routine checkup. She is 5 feet 4 inches tall and weighs 180 pounds. Her
major complaint is pain in her joints. She is retired and has had to give up her volunteer work because of her discomfort.
She was told her diagnosis was osteoarthritis about 5 years ago. Which would be excluded from the clinical pathway for this
client?
a. Decrease the calorie count of her daily diet
b. Take warm baths when arising
c. Slide items across the floor rather than lift them
d. Place items so that it is necessary to bend or stretch to reach them
250.A client is admitted from the emergency department with severe-pain and edema in the right foot. His diagnosis is gouty
arthritis. When developing a plan of care, which action would have the highest priority?
a. Apply hot compresses to the affected joints
b. Stress the importance of maintaining good posture to prevent deformities
c. Administer salicylates to minimize the inflammatory reaction
d. Ensure an intake of at least 3000 ml of fluid per day
251.A client had a laminectomy and spinal fusion yesterday. Which statement is to be excluded from your plan of care?
a. Before log rolling, place a pillow under the clients head and a pillow between the clients legs
b. Before log rolling, remove the pillow from under the clients head and use no pillows between the clients legs
c. Keep the knees slightly flexed while the client is lying in a semi-Fowlers position in bed
d. Keep a pillow under the clients head as needed for comfort
252.The nurse is assisting in planning care for a client with a diagnosis of immune deficiency. The nurse would incorporate
which of the ff. as a priority in the plan of care?
a. providing emotional support to decrease fear
b. protecting the client from infection
c. encouraging discussion about lifestyle changes
d. identifying factors that decreased the immune function
253.Robin, an obese 32 year old, is admitted to the hospital after an automobile accident. She has a fractured hip and is brought
to the OR for surgery. After surgery Joy is to receive a piggy-back of Clindamycin phosphate (Cleocin) 300 mg in 50 ml of
D5W. The piggyback is to infuse in 20 minutes. The drop factor of the IV set is 10 gtt/ml. The nurse should set the
piggyback to flow at:
a. 25 gtt/min b. 30 gtt/min c. 35 gtt/min d. 45 gtt/min
254.The day after her surgery Joy asks the nurse how she might lose weight. Before answering her question, the nurse should
bear in mind that long-term weight loss best occurs when:
a. Fats are controlled in the diet
b. Eating habits are altered
c. Carbohydrates are regulated
d. Exercise is part of the program
255.The nurse teaches Joy, an obese client, the value of aerobic exercises in her weight reduction program. The nurse would
know that this teaching was effective when Joy says that exercise will:
a. Increase her lean body mass
b. Lower her metabolic rate
c. Decrease her appetite
d. Raise her heart rate
256.The physician orders non-weight bearing with crutches for Jem, who had surgery for a fractured hip. The most important
activity to facilitate walking with crutches before ambulation begun is:
a. Exercising the triceps, finger flexors, and elbow extensors
b. Sitting up at the edge of the bed to help strengthen back muscles
c. Doing isometric exercises on the unaffected leg
d. Using the trapeze frequently for pull-ups to strengthen the biceps muscles
257.The nurse recognizes that a client understood the demonstration of crutch walking when she places her weight on:
a. The palms and axillary regions c. The palms of her hands
b. Both feet placed wide apart d. Her axillary regions
258.Freck is a 46 year-old radio technician who is admitted because of mild chest pain. He is 5 feet, 8 inches tall and weighs
190 pounds. He is diagnosed with a myocardial infarct. Morphine sulfate, Diazepam (Valium) and Lidocaine are prescribed.
The physician orders 8 mg of Morphine Sulfate to be given IV. The vial on hand is labeled 1 ml/ 10 mg. The nurse should
administer:
a. 8 minims b. 10 minims c. 12 minims d. 15 minims
259.Freck asks the nurse why he is receiving the injection of Morphine after he was hospitalized for severe anginal pain. The
nurse replies that it:
a. Will help prevent erratic heart beats
b. Relieves pain and decreases level of anxiety
c. Decreases anxiety
d. Dilates coronary blood vessels
260.Oxygen 3L/min by nasal cannula is prescribed for Joey who is admitted to the hospital for chest pain. The nurse institutes
safety precautions in the room because oxygen:
a. Converts to an alternate form of matter
b. Has unstable properties

20
c. Supports combustion
d. Is flammable
261.Mariel is ordered laboratory tests after she is admitted to the hospital for angina. The isoenzyme test that is the most
reliable early indicator of myocardial insult is:
a. SGPT b. LDH c. CK-MB d. AST
262.An early finding in the EKG of a client with an infarcted mycardium would be:
a. Disappearance of Q waves c. Absence of P wave
b. Elevated ST segments d. Flattened T waves
263.Wally, who had a myocardial infarction 2 days earlier, has been complaining to the nurse about issues related to his hospital
stay. The best initial nursing response would be to:
a. Allow him to release his feelings and then leave him alone to allow him to regain his composure
b. Refocus the conversation on his fears, frustrations and anger about his condition
c. Explain how his being upset dangerously disturbs his need for rest
d. Attempt to explain the purpose of different hospital routines
264.Wally, who is admitted to the hospital for chest pain, asks the nurse, Is it still possible for me to have another heart attack if
I watch my diet religiously and avoid stress? The most appropriate initial response would be for the nurse to:
a. Suggest he discuss his feelings of vulnerability with his physician.
b. Tell him that he certainly needs to be especially careful about his diet and lifestyle.
c. Avoid giving him direct information and help him explore his feelings
d. Recognize that he is frightened and suggest he talk with the psychiatrist or counselor.
265.Leona is diagnosed to have Pernicious anemia. The physician orders 0.2 mg of Cyanocobalamin (Vitamin B12) IM.
Available is a vial of the drug labeled 1 ml= 100 mcg. The nurse should administer:
a. 0.5 ml b. 1.0 ml c. 1.5 ml d. 2.0 ml
266.Health teachings to be given to a client with Pernicious Anemia regarding her therapeutic regimen concerning Vit. B12 will
include:
a. Oral tablets of Vitamin B12 will control her symptoms
b. IM injections are required for daily control
c. IM injections once a month will maintain control
d. Weekly Z-track injections provide needed control
267.The nurse knows that a client with Pernicious Anemia understands the teaching regarding the vitamin B12 injections when
she states that she must take it:
a. When she feels fatigued
b. During exacerbations of anemia
c. Until her symptoms subside
d. For the rest of her life
268.Bernon, a 45 year old artist, has recently had an abdominoperineal resection and colostomy. Bernon accuses the nurse of
being uncomfortable during a dressing change, because his wound looks terrible. The nurse recognizes that the client is
using the defense mechanism known as:
a. Reaction Formation c. Intellectualization
b. Sublimation d. Projection
269.When preparing to teach a client with colostomy how to irrigate his colostomy, the nurse should plan to perform the
procedure:
a. When the client would have normally had a bowel movement
b. After the client accepts he had a bowel movement
c. Before breakfast and morning care
d. At least 2 hours before visitors arrive
270.When observing an ostomate do a return demonstration of the colostomy irrigation, the nurse notes that he needs more
teaching if he:
a. Stops the flow of fluid when he feels uncomfortable
b. Lubricates the tip of the catheter before inserting it into the stoma
c. Hangs the bag on a clothes hook on the bathroom door during fluid insertion
d. Discontinues the insertion of fluid after only 500 ml of fluid has been instilled
271.When doing colostomy irrigation at home, a client with colostomy should be instructed to report to his physician:
a. Abdominal cramps during fluid inflow
b. Difficulty in inserting the irrigating tube
c. Passage of flatus during expulsion of feces
d. Inability to complete the procedure in half an hour
272.The nurse would know that dietary teaching had been effective for a client with colostomy when he states that he will eat:
a. Food low in fiber so that there is less stool
b. Everything he ate before the operation but will avoid those foods that cause gas
c. Bland foods so that his intestines do not become irritated
d. Soft foods that are more easily digested and absorbed by the large intestines
273.A chest tube with water seal drainage is inserted to a client following a multiple chest injury. A few hours later, the clients
chest tube seems to be obstructed. The most appropriate nursing action would be to:
a. Prepare for chest tube removal
b. Milk the tube toward the collection container as ordered
c. Arrange for a stat Chest x-ray film
d. Clam the tube immediately
274.The observation that indicates a desired response to thoracostomy drainage of a client with chest injury is:

21
a. Increased breath sounds
b. Constant bubbling in the drainage chamber
c. Crepitus detected on palpation of chest
d. Increased respiratory rate
275.In the evaluation of a clients response to fluid replacement therapy, the observation that indicates adequate tissue
perfusion to vital organs is:
a. Urinary output is 30 ml in an hour
b. Central venous pressure reading of 2 cm H2O
c. Pulse rates of 120 and 110 in a 15 minute period
d. Blood pressure readings of 50/30 and 70/40 within 30 minutes
276.A client with multiple injury following a vehicular accident is transferred to the critical care unit. He begins to complain of
increased abdominal pain in the left upper quadrant. A ruptured spleen is diagnosed and he is scheduled for emergency
splenectomy. In preparing the client for surgery, the nurse should emphasize in his teaching plan the:
a. Complete safety of the procedure
b. Expectation of postoperative bleeding
c. Risk of the procedure with his other injuries
d. Presence of abdominal drains for several days after surgery
277.To promote continued improvement in the respiratory status of a client following chest tube removal after a chest surgery for
multiple rib fracture, the nurse should:
a. Encourage bed rest with active and passive range of motion exercises
b. Encourage frequent coughing and deep breathing
c. Turn him from side to side at least every 2 hours
d. Continue observing for dyspnea and crepitus
278.The key factor in accurately assessing how body image changes will be dealt with by the client is the:
a. Extent of body change present
b. Suddenness of the change
c. Obviousness of the change
d. Clients perception of the change
279.Raygen is diagnosed as having myelocytic leukemia and is admitted to the hospital for chemotherapy. Larry discusses his
recent diagnosis of leukemia by referring to statistical facts and figures. The nurse recognizes that Larry is using the
defense mechanism known as:
a. Reaction formation c. Intellectualization
b. Sublimation d. Projection
280.The laboratory results of the client with leukemia indicate bone marrow depression. The nurse should encourage the client
to:
a. Increase his activity level and ambulate frequently
b. Sleep with the head of his bed slightly elevated
c. Drink citrus juices frequently for nourishment
d. Use a soft toothbrush and electric razor
281.Joselito receives a blood transfusion and develops flank pain, chills, fever and hematuria. The nurse recognizes that Dennis
is probably experiencing:
a. An anaphylactic transfusion reaction
b. An allergic transfusion reaction
c. A hemolytic transfusion reaction
d. A pyrogenic transfusion reaction
282.During and 8 hour shift, Mario drinks two 6 oz. cups of tea and vomits 125 ml of fluid. During this 8 hour period, his fluid
balance would be:
a. +55 ml b. +137 ml c. +235 ml d. +485 ml
283.Mr. Obama is admitted to the hospital with a diagnosis of Left-sided CHF. In the assessment, the nurse should expect to
find:
a. Crushing chest pain c. Extensive peripheral edema
b. Dyspnea on exertion d. Jugular vein distention
284.The physician orders on a client with CHF a cardiac glycoside, a vasodilator, and furosemide (Lasix). The nurse
understands Lasix exerts is effects in the:
a. Distal tubule c. Glomerulus of the nephron
b. Collecting duct d. Ascending limb of the loop of Henle
285.Mr. Obama, a client with CHF, has been receiving a cardiac glycoside, a diuretic, and a vasodilator drug. His apical pulse
rate is 44 and he is on bed rest. The nurse concludes that his pulse rate is most likely the result of the:
a. Diuretic c. Bed-rest regimen
b. Vasodilator d. Cardiac glycoside
286.The diet ordered for a client with CHF permits him to have a 190 g of carbohydrates, 90 g of fat and 100 g of protein. The
nurse understands that this diet contains approximately:
a. 2200 calories c. 2800 calories
b. 2000 calories d. 1600 calories
287.After the acute phase of congestive heart failure, the nurse should expect the dietary management of the client to include
the restriction of:
a. Magnesium c. Potassium
b. Sodium d. Calcium

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288.Julio develops GI bleeding and is admitted to the hospital. An important etiologic clue for the nurse to explore while taking
his history would be:
a. The medications he has been taking
b. Any recent foreign travel
c. His usual dietary pattern
d. His working patterns
289.The meal pattern that would probably be most appropriate for a client recovering from GI bleeding is:
a. Three large meals large enough to supply adequate energy
b. Regular meals and snacks to limit gastric discomfort
c. Limited food and fluid intake when he has pain
d. A flexible plan according to his appetite
290.A client with a history of recurrent GI bleeding is admitted to the hospital for a gastrectomy. Following surgery, the client has
a nasogastric tube to low continuous suction. He begins to hyperventilate. The nurse should be aware that this pattern will
alter his arterial blood gases by:
a. Increasing HCO3 c. Decreasing pH
b. Decreasing PCO2 d. Decreasing PO2
291.Routine postoperative IV fluids are designed to supply hydration and electrolyte and only limited energy. Because 1 L of a
5% dextrose solution contains 50 g of sugar, 3 L per day would apply approximately:
a. 400 Kilocalories c. 800 Kilocalories
b. 600 Kilocalories d. 1000 Kilocalories
292.Thrombus formation is a danger for all postoperative clients. The nurse should act independently to prevent this
complication by:
a. Encouraging adequate fluids
b. Applying elastic stockings
c. Massaging gently the legs with lotion
d. Performing active-assistive leg exercises
293.An unconscious client is admitted to the ICU, IV fluids are started and a Foley catheter is inserted. With an indwelling
catheter, urinary infection is a potential danger. The nurse can best plan to avoid this problem by:
a. Emptying the drainage bag frequently
b. Collecting a weekly urine specimen
c. Maintaining the ordered hydration
d. Assessing urine specific gravity
294.The nurse performs full range of motion on a bedridden clients extremities. When putting his ankle through range of motion,
the nurse must perform:
a. Flexion, extension and left and right rotation
b. Abduction, flexion, adduction and extension
c. Pronation, supination, rotation, and extension
d. Dorsiflexion, plantar flexion, eversion and inversion
295.A client has been in a coma for 2 months. The nurse understands that to prevent the effects of shearing force on the skin,
the head of the bed should be at an angle of:
a. 30 degrees c. 60 degrees
b. 45 degrees d. 90 degrees
296.Gon, age 62, is scheduled for a TURP after being diagnosed with a Benign Prostatic Hyperplasia (BPH). As part of the
preoperative teaching, the nurse should tell the client that after surgery:
a. Urinary control may be permanently lost to some degree
b. Urinary drainage will be dependent on a urethral batheter for 24 hours
c. Frequency and burning on urination will last while the cystotomy tube is in place
d. His ability to perform sexually will be permanently impaired
297.The transurethral resection of the prostate is performed on a client with BPH. Following surgery, nursing care should
include:
a. Changing the abdominal dressing
b. Maintaining patency of the cystotomy tube
c. Maintaining patency of a three-way Foley catheter for cystoclysis
d. Observing for hemorrhage and wound infection
298.In the early postoperative period following a transurethral surgery, the most common complication the nurse should observe
for is:
a. Sepsis c. Leakage around the catheter
b. Hemorrhage d. Urinary retention with overflow
299.Following prostate surgery, the retention catheter is secured to the clients leg causing slight traction of the inflatable balloon
against the prostatic fossa. This is done to:
a. Limit discomfort c. Reduce bladder spasms
b. Provide hemostasis d. Promote urinary drainage
300.Twenty-four hours after TURP surgery, the client tells the nurse he has lower abdominal discomfort. The nurse notes that
the catheter drainage has stopped. The nurses initial action should be to:
a. Irrigate the catheter with saline c. Remove the catheter
b. Milk the catheter tubing d. Notify the physician
301.Helaiza is admitted to the surgical unit for a subtotal thyroidectomy. She is diagnosed with Graves Disease. When
assessing Lucy, the nurse would expect to find:

23
a. Lethargy, weight gain, and forgetfulness
b. Weight loss, protruding eyeballs, and lethargy
c. Weight loss, exopthalmos and restlessness
d. Constipation, dry skin, and weight gain
302.Helaiza undergoes Subtotal Thyroidectomy for Graves Disease. In planning for the clients return from the OR, the nurse
would consider that in a subtotal thyroidectomy:
a. The entire thyroid gland is removed
b. A small part of the gland is left intact
c. One parathyroid gland is also removed
d. A portion of the thyroid and four parathyroids are removed
303.Before a post- thyroidectomy client returns to her room from the OR, the nurse plans to set up emergency equipment, which
should include:
a. A crash cart with bed board
b. A tracheostomy set and oxygen
c. An airway and rebreathing mask
d. Two ampules of sodium bicarbonate
304.When a post-thyroidectomy client returns from surgery the nurse assesses her for unilateral injury of the laryngeal nerve
every 30 to 60 minutes by:
a. Observing for signs of tetany
b. Checking her throat for swelling
c. Asking her to state her name out loud
d. Palpating the side of her neck for blood seepage
305.On a post-thyroidectomy clients discharge, the nurse teaches her to observe for signs of surgically induced hypothyroidism.
The nurse would know that the client understands the teaching when she states she should notify the physician if she
develops:
a. Intolerance to heat c. Progressive weight loss
b. Dry skin and fatigue d. Insomnia and excitability
306.A clients exopthalmos continues inspite of thyroidectomy for Graves Disease. The nurse teaches her how to reduce
discomfort and prevent corneal ulceration. The nurse recognizes that the client understands the teaching when she says: I
should:
a. Elevate the head of my bed at night
b. Avoid moving my extra-ocular muscles
c. Avoid using a sleeping mask at night
d. Avoid excessive blinking
307.Clara is a 37-year old cook. She is admitted for treatment of partial and full-thickness burns of her entire right lower
extremity and the anterior portion of her right upper extremity. Her respiratory status is compromised, and she is in pain and
anxious. Performing an immediate appraisal, using the rule of nines, the nurse estimates the percent of Claras body
surface that is burned is:
A. 4.5% B. 9% C. 18 % D. 22.5%
308.The nurse applies mafenide acetate (Sulfamylon cream) to Clara, who has second and third degree burns on the right
upper and lower extremities, as ordered by the physician. This medication will:
a. Inhibit bacterial growth c. Prevent scar tissue formation
b. Relieve pain from the burn d. Provide chemical debridement
309.Forty-eight hours after a burn injury, the physician orders for the client 2 liters of IV fluid to be administered q12 h. The drop
factor of the tubing is 10 gtt/ml. The nurse should set the flow to provide:
a. 18 gtt/min c. 32 gtt/min
b. 28 gtt/min d. 36 gtt/min
310.Clara, a burn client, receives a temporary heterograft (pig skin) on some of her burns. These grafts will:
a. Debride necrotic epithelium
b. Be sutured in place for better adherence
c. Relieve pain and promote rapid epithelialization
d. Frequently be used concurrently with topical antimicrobials
311. A client with burns on the chest has periodic episodes of dyspnea. The position that would provide for the greatest
respiratory capacity would be the:
a. Semi-fowlers position c. Orthopneic position
b. Sims position d. Supine position
312.Claire, a 20- year old college student is admiited to the hospital with a tentative diagnosis of myasthenia gravis. She is
scheduled to have a series of diagnostic studies for myasthenia gravis, including a Tensilon test. In preparing her for this
procedure, the nurse explains that her response to the medication will confirm the diagnosis if Tensilon produces:
a. Brief exaggeration of symptoms
b. Prolonged symptomatic improvement
c. Rapid but brief symptomatic improvement
d. Symptomatic improvement of just the ptosis
313.The most significant initial nursing observations that need to be made about a client with myasthenia include:
a. Ability to chew and speak distinctly
b. Degree of anxiety about her diagnosis
c. Ability to smile an to close her eyelids
d. Respiratory exchange and ability to swallow

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314.Karla is diagnosed with myasthenia gravis and pyridostigmine bromide (Mestinon) therapy is started. The Mestinon dosage
is frequently changed during the first week. While the dosage is being adjusted, the nurses priority intervention is to:
a. Administer the medication exactly on time
b. Administer the medication with food or mild
c. Evaluate the clients muscle strength hourly after medication
d. Evaluate the clients emotional side effects between doses
315.Mrs. Chuang a 78 year old client is admitted with the diagnosis of mild chronic heart failure. The nurse expects to hear
when listening to clients lungs indicative of chronic heart failure would be:
a. Stridor b. Crackles c. Wheezes d. Friction rubs
316.Which of the following should the nurse teach the client about the signs of digitalis toxicity?
a. Increased appetite
b. Elevated blood pressure
c. Skin rash over the chest and back
d. Visual disturbances such as seeing yellow spots
317.Nurse Janelle teaches a client with heart failure to take oral Furosemide in the morning. The reason for this is to help
a. Retard rapid drug absorption
b. Excrete excessive fluids accumulated at night
c. Prevents sleep disturbances during night
d. Prevention of electrolyte imbalance
318.What would be the primary goal of therapy for a client with pulmonary edema and heart failure?
a. Enhance comfort
b. Increase cardiac output
c. Improve respiratory status
d. Peripheral edema decreased
319.Nurse Catherine is caring for a client with head injury and monitoring the client with decerebrate posturing. Which of the
following is a characteristic of this type of posturing?
a. Upper extremity flexion with lower extremity flexion
b. Upper extremity flexion with lower extremity extension
c. Extension of the extremities after a stimulus
d. Flexion of the extremities after stimulus
320.A female client is taking Cascara Sagrada. Nurse Betty informs the client that the following maybe experienced as side
effects of this medication:
a. GI bleeding c. Abdominal cramps
b. Peptic ulcer disease d. Partial bowel obstruction
321.Dr. Santos orders a continuous intravenous nitroglycerin infusion for the client suffering from myocardial infarction. Which of
the following is the most essential nursing action?
a. Monitoring urine output frequently
b. Monitoring blood pressure every 4 hours
c. Obtaining serum potassium levels daily
d. Obtaining infusion pump for the medication
322.During the second day of hospitalization of the client after a Myocardial Infarction. Which of the following is an expected
outcome?
a. Able to perform self-care activities without pain
b. Severe chest pain
c. Can recognize the risk factors of Myocardial Infarction
d. Can Participate in cardiac rehabilitation walking program
323.A 68 year old client is diagnosed with a right-sided brain attack and is admitted to the hospital. In caring for this client, the
nurse should plan to:
a. Application of elastic stockings to prevent flaccid by muscle
b. Use hand roll and extend the left upper extremity on a pillow to prevent contractions
c. Use a bed cradle to prevent dorsiflexion of feet
d. Do passive range of motion exercise
324.A 64 year old male client with a long history of cardiovascular problem including hypertension and angina is to be scheduled
for cardiac catheterization. During pre cardiac catheterization teaching, Nurse Sinshia should inform the client that the
primary purpose of the procedure is:
a. To determine the existence of CHD
b. To visualize the disease process in the coronary arteries
c. To obtain the heart chambers pressure
d. To measure oxygen content of different heart chambers
325.During the first several hours after a cardiac catheterization, it would be most essential for nurse Sinshia to:
a. Elevate clients bed at 45
b. Instruct the client to cough and deep breathe every 2 hours
c. Frequently monitor clients apical pulse and blood pressure
d. Monitor clients temperature every hour
326.Glena who has undergone mitral valve replacement suddenly experiences continuous bleeding from the surgical incision
during postoperative period. Which of the following pharmaceutical agents should Nurse Kate prepare to administer to
Kate?
a. Protamine Sulfate c. Vitamin C
b. Quinidine Sulfate d. Coumadin

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327.In reducing the risk of endocarditis, good dental care is an important measure. To promote good dental care in client with
mitral stenosis in teaching plan should include proper use of:
a. Dental floss c. Manual toothbrush
b. Electric toothbrush d. Irrigation device
328.Among the following signs and symptoms, which would most likely be present in a client with mitral gurgitation?
a. Altered level of consciousness
b. Exceptional Dyspnea
c. Increase creatine phospholinase concentration
d. Chest pain
329.Elouise with a history of chronic infection of the urinary system complains of urinary frequency and burning sensation. To
figure out whether the current problem is in renal origin, the nurse should assess whether the client has discomfort or pain
in the:
a. Urinary meatus c. Suprapubic area
b. Pain in the Labium d. Right or left costovertebral angle
330.Nurse Joen is evaluating the renal function of a male client. After documenting urine volume and characteristics, Nurse
Joen assesses which signs as the best indicator of renal function:
a. Blood pressure c. Distension of the bladder
b. Consciousness d. Pulse rate
331.Lito suddenly experiences a seizure, and Nurse Giselle notice that John exhibits uncontrollable jerking movements. Nurse
Giselle documents that Lito experienced which type of seizure?
a. Tonic seizure c. Myoclonic seizure
b. Absence seizure d. Clonic seizure
332.Smoking cessation is critical strategy for the client with Burghers disease, Nurse Precious anticipates that the male client
will go home with a prescription for which medication?
a. Paracetamol c. Nitroglycerin
b. Ibuprofen d. Nicotine (Nicotrol)
333.Nurse Kimi has been assigned to a client with Raynauds disease. Nurse Lilly realizes that the etiology of the disease is
unknown but it is characterized by:
a. Episodic vasospastic disorder of capillaries
b. Episodic vasospastic disorder of small veins
c. Episodic vasospastic disorder of the aorta
d. Episodic vasospastic disorder of the small arteries
334.Nurse Dora should explain to male client with diabetes that self-monitoring of blood glucose is preferred to urine glucose
testing because:
a. More accurate c. It is easy to perform
b. Can be done by the client d. It is not influenced by drugs
335.Vana weighed 210 pounds on admission to the hospital. After 2 days of diuretic therapy, Jessie weighs 205.5 pounds. The
nurse could estimate the amount of fluid Jessie has lost
a. 0.3 L b. 1.5 L c. 2.0 L d. 3.5 L
336.Nurse Lucky is aware that the shift of body fluids associated with Intravenous administration of albumin occurs in the
process of:
a. Osmosis c. Active transport
b. Diffusion d. Filtration
337.Fiona a 52 year old client with a fractured left tibia has a long leg cast and she is using crutches to ambulate. Nurse Xena
assesses for which sign and symptom that indicates complication associated with crutch walking?
a. Left leg discomfort c. Triceps muscle spasm
b. Weak biceps brachii d. Forearm weakness
338.A female client is experiencing painful and rigid abdomen and is diagnosed with perforated peptic ulcer. A surgery has been
scheduled and a nasogastric tube is inserted. The nurse should place the client before surgery in
a. Sims position c. Semi-fowlers position
b. Supine position d. Dorsal recumbent position
339.Which nursing intervention ensures adequate ventilating exchange after surgery?
a. Remove the airway only when client is fully conscious
b. Assess for hypoventilation by auscultating the lungs
c. Position client laterally with the neck extended
d. Maintain humidified oxygen via nasal canula
340.Mc who has undergone thoracic surgery has chest tube connected to a water-seal drainage system attached to suction.
Presence of excessive bubbling is identified in water-seal chamber, the nurse should
a. Strip the chest tube catheter
b. Check the system for air leaks
c. Recognize the system is functioning correctly
d. Decrease the amount of suction pressure
341.During the initial postoperative period of the clients stoma. The nurse evaluates which of the following observations should
be reported immediately to the physician?
a. Stoma is dark red to purple
b. Stoma is oozes a small amount of blood
c. Stoma is lightly edematous
d. Stoma does not expel stool

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342.Bianca which has diagnosed with ulcerative colitis is following physicians order for bed rest with bathroom privileges. What
is the rationale for this activity restriction?
a. Prevent injury c. Reduce intestinal peristalsis
b. Promote rest and comfort d. Conserve energy
343.Nurse Dianne should regularly assess the clients ability to metabolize the total parenteral nutrition (TPN) solution
adequately by monitoring the client for which of the following signs:
a. Hyperglycemia
b. Hypoglycemia
c. Hypertension
d. Elevate blood urea nitrogen concentration
344.A female client has an acute pancreatitis. Which of the following signs and symptoms the nurse would expect to see?
a. Constipation c. Ascites
b. Hypertension d. Jaundice
345.A client is suspected to develop tetany after a subtotal thyroidectomy. Which of the following symptoms might indicate
tetany?
a. Tingling in the fingers
b. Pain in hands and feet
c. Tension on the suture lines
d. Bleeding on the back of the dressing
346.A 58 year old woman has newly diagnosed with hypothyroidism. The nurse is aware that the signs and symptoms of
hypothyroidism include:
a. Diarrhea c. Tachycardia
b. Vomiting d. Weight gain
347.A client has undergone for an ileal conduit, the nurse in charge should closely monitor the client for occurrence of which of
the following complications related to pelvic surgery?
a. Ascites c. Inguinal hernia
b. Thrombophlebitis d. Peritonitis
348.Dr. Ramos is about to defibrillate a client in ventricular fibrillation and says in a loud voice clear. What should be the action
of the nurse?
a. Places conductive gel pads for defibrillation on the clients chest
b. Turn off the mechanical ventilator
c. Shuts off the clients IV infusion
d. Steps away from the bed and make sure all others have done the same
349.A client with acute renal failure is aware that the most serious complication of this condition is:
a. Constipation c. Infection
b. Anemia d. Platelet dysfunction
350.Nurse Levi is caring for clients in the OR. The nurse is aware that the last physiologic function that the client loss during the
induction of anesthesia is:
a. Consciousness c. Respiratory movement
b. Gag reflex d. Corneal reflex
351.The nurse is assessing a client with pleural effusion. The nurse expect to find:
a. Deviation of the trachea towards the involved side
b. Reduced or absent of breath sounds at the base of the lung
c. Moist crackles at the posterior of the lungs
d. Increased resonance with percussion of the involved area
352.The Nurse is assessing the clients casted extremity for signs of infection. Which of the following findings is indicative of
infection?
a. Edema c. Coolness of the skin
b. Weak distal pulse d. Presence of hot spot on the cast
353.Nurse Bella is performing an otoscopic examination on a female client with a suspected diagnosis of mastoiditis. Nurse
Bella would expect to note which of the following if this disorder is present?
a. Transparent tympanic membrane
b. Thick and immobile tympanic membrane
c. Pearly colored tympanic membrane
d. Mobile tympanic membrane
354.A client is suspected of developing diabetes insipidus. Which of the following is the most effective assessment?
a. Taking vital signs every 4 hours
b. Monitoring blood glucose
c. Assessing ABG values every other day
d. Measuring urine output hourly
355.A 58 year old client is suffering from acute phase of rheumatoid arthritis. Which of the following would the nurse in charge
identify as the lowest priority of the plan of care?
a. Prevent joint deformity
b. Maintaining usual ways of accomplishing task
c. Relieving pain
d. Preserving joint function
356.Which of the following is not a sign of thromboembolism?
a. Edema b. Swelling c. Redness d. Coolness

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357.A client has undergone bone biopsy. Which nursing action should the nurse provide after the procedure?
a. Administer analgesics via IM
b. Monitor vital signs
c. Monitor the site for bleeding, swelling and hematoma formation
d. Keep area in neutral position
358.A client is suffering from low back pain. Which of the following exercises will strengthen the lower back muscle of the client?
a. Tennis b. Basketball c. Diving d. Swimming
359.A client with peptic ulcer is being assessed by the nurse for gastrointestinal perforation. The nurse should monitor for:
a. (+) guaiac stool test
b. Slow, strong pulse
c. Sudden, severe abdominal pain
d. Increased bowel sounds
360.A client has undergone surgery for retinal detachment. Which of the following goal should be prioritized?
a. Prevent an increase intraocular pressure
b. Alleviate pain
c. Maintain darkened room
d. Promote low-sodium diet
361.A Client with glaucoma has been prescribed with miotics. The nurse is aware that miotics is for:
a. Constricting pupil c. Constricting intraocular vessel
b. Relaxing ciliary muscle d. Paralyzing ciliary muscle
362.When teaching a client about the signs of colorectal cancer, the nurse stresses that the most common complaint of persons
with colorectal cancer is
a.Rectal bleeding c.Change in bowel habits
b.Abdominal pain d.. Change in caliber of stools
363.A middle age male client has an adenocarcinoma of the colon. The physician suspects that this has metastasized and
orders a CAT scan of the liver. When preparing the client for the CAT scan, the nurse should explain that
a.After the procedure, he will need to rest in bed for about six hours to prevent complications
b.There will be some discomfort during the procedure but the physician will administer analgesic
c.He will be in twilight type of sleep during the procedure but maybe able to hear people talking in the same room
d.He will be given an IV infusion containing a contrast medium before the procedure and must lie as still as possible for a
period of time
364.On the second day following an abdominoperineal resection, the nurse anticipates that the colostomy stoma will appear
a.Dry, pale pink and flush with the skin
b.Moist red and raised above the skin surface
c.Dry, purple and depressed below the skin surface
d.Moist, pink flush with the skin and painful when touched
365.The nurse plans to teach a client to irrigate a new sigmoid colostomy when the:
a.Stool starts to become formed
b.Clients can lie on the side comfortably
c.Abdominal incision is closed and contamination is no longer a danger
d.Perineal wound heals and the client can sit comfortably on the commode
366.A client returns from surgery with a permanent colostomy. During the first 24 hours the colostomy does not drain. The nurse
should realize that this is a result of:
a.Intestinal edema following surgery
b.A presurgical decrease in fluid intake
c.The absence of gastro intestinal motility
d.Proper functioning of nasogastric suction
367.A client has colostomy because of cancer of the colon. Postoperatively, it would be most therapeutic for the nurse to
a.Empty the colostomy bag when it is three fourth full
b.Allow one half inch between the stoma and the colostomy bag
c.Help the client to remove the bag on the first postop day
d.Apply stoma adhesive around the stoma before attaching the bag
368.The nurse would know that dietary teaching for a client with colostomy had been effective when the client states It is
important that I eat
a.Food low in fiber so that there is less stool
b.Bland foods so that my intestines do not become irritated
c.Everything I ate before the operation but avoiding foods that cause gas
d.Soft foods that are most easily digested and absorb by my large intestine
369.The physician orders bed rest for a client after surgery. The nurse is aware that the most beneficial method of preventing
skin breakdown while the client is confined to the bed is to:
a.Massage the skin with cream
b.Use a sheepskin pad on the bed
c.Promote passive range of motion
d.Encourage independent movement
370.The physician orders bed rest for a client with cellulitis of the leg. The nurse understands that the primary purpose of bed
rest for this client is to:
a.Decrease catabolism to promote healing at the site of injury
b.Lower the metabolic rate in an attempt to help reduce the fever
c.Reduce the energy demands on the body in the presence of infection

28
d.Limit muscle contractions that may force causative organisms into blood stream
371.A client develops an infection at a catheter insertion site. The nurse uses the term iatrogenic when describing the infection
because it resulted from
a.Poor personal hygiene c. Inadequate dietary patterns
b.A therapeutic procedure d The clients developmental level
372.A client develops an infection of an abdominal incision overhears the nurses say that it is a nosocomial infection. The client
asks the nurse what this means. The nurse should reply:
a.fection you had prior to hospitalization has flared up
b.You acquired the infection after being admitted to the hospital
c.This is highly contagious infection requiring protective isolation
d.As a result of medical treatment, you have developed secondary infection
373.An obese adult who smoke 3 packs of cigarettes daily is admitted for major abdominal surgery. Postoperatively, the most
appropriate laboratory value that the nurse should monitor routinely that would reflect the clients respiratory status is the:
a.PO2 bPCO2 c. Hemoglobin d. O2 saturation
374.A client who has pneumonectomy is in the post anesthesia care unit. The nurses primary concern at this time would be to
maintain:
a.Blood replacement c. Closed chest drainage
b.Ventilatory exchange d. Supplementary oxygenation
375.When assessing the breath sounds of a client with COPD, the nurse hears rhonchi. Rhonchi can best describe as:
a.Snorting during inspiratory phase
b.Moist rumbling sound that clears after coughing
c.Musical sound more pronounced during expiration
d.Crackling inspiratory sounds unchanged with coughing
376. A client is brought to the hospital with deep partial thickness burns on the face and full thickness burns on the neck, entire
anterior chest and right arm. When assessing heat inhalation, the nurse should first observe for:
a.Changes in the chest x ray finding
b.Sputum that contains particles of blood
c.Nasal discharges containing carbon particles
d.Changes ion the arterial blood gases consistent with acidosis
377.The best method to assess for stridor in immediate postop period after a radical neck dissection is to
a.Listen with stethoscope over the trachea
b.Assess the clients ability to cough and deep breathe
c.Determine the clients ability to do neck exercises
d.Listen with stethoscope over the base of the lungs
378.The nurses physical assessment of a client with heart failure reveals tachypnea and bilateral crackles. The nurse should:
a.nitiate O2 therapy
b.assess a pleural friction rub
c.Obtain a chest x ray film immediately
d.Position the client in Fowlers position
379.When discussing breathing exercises with a post op client, the nurse should include teaching the client to:
a.Take short frequent breaths
b.Exhale with open mouth open
c.Plan to do exercise twice a day
d.Place the hand on the abdomen and feel it rise
380.A client is admitted to the Intensive Care Unit with a diagnosis of Acute Respiratory Distress Syndrome. When assessing
the client, the nurse should expect to find:
a.Hypertension c. An altered mental status
b.Tenacious sputum d. A slowed rate of breathing
381.A clients respiratory status necessitates endotracheal intubation and positive pressure ventilation. The most immediate
nursing intervention for this client at this time would be to:
a.Prepare the client for emergency surgery
b.Facilitate the clients verbal communication
c.Assess the clients response to mechanical ventilation
d.Maintain sterility of the ventilation system the client is using
382.A client has been admitted to the emergency department with multiple injuries including fractured ribs. Because of the
clients fractured ribs, the nurse should assess for signs of
a.Pneumonitis c. Pulmonary edema
b.Hematemesis d. Respiratory acidosis
383.A client is placed on a ventilator. Because hyperventilation can occur when mechanical ventilation is used, the nurse should
monitor the client for signs of
a.Hypoxia c. Metabolic acidosis
b.Hypercapnia d. Respiratory alkalosis
384.After surgery in the inguinal area, the client complains of pain on the right side of the chest becomes dypneic and begins to
cough violently. The nurse suspects that a pulmonary embolus has occurred. The nurse immediately should:
a.Auscultate the chest
b.Obtain vital signs
c.Elevate the head of the bed
d.Position the client on the right side

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385.A client with pulmonary embolus is intubated and place on mechanical ventilation. When suctioning the endotracheal tube
the nurse should:
a.Apply suction while inserting the catheter
b.Hyperoxygenate with oxygen before and after suctioning
c.Use short, jabbing movements of the catheter to loosen secretions
d.Suction two to three times in quick succession to remove secretions
386.A 21 year old aspiring actress is admitted for rhinoplasty to improve her appearance and facilitate her breathing. When
monitoring for hemorrhage after the surgery, the nurse should assess specifically for the presence of
a.Facial edema
b.Excessive swallowing
c.Pressure around eyes
d.Serosanguinous drainage on dressing
387.A client with emphysema is short of breath and using accessory muscles of respiration. The nurse recognizes that the
clients dyspnea is caused by
a.Spasms of the bronchi that traps the air
b.An increase in the vital capacity if the lungs
c.A too rapid expulsion of air from the alveoli
d.Difficulty in expelling the air trapped in the alveoli
388.A client with an acute emphysemic episode is dyspneic and anxious. Todecrease the dyspnea, the nurses first action
should be to:
a.Increase the O2 to 6L/min
b.Encourage rhythmical breathing
c.Check vital signs including BP
d.Have the client breath trough brown bag
389.A client with COPD is predisposed to develop CO2 necrosis. Therefore, the nurse should
a.Initiate pulmonary hygiene to clear air passage of trapped mucus
b.Encourage continuous rapid panting to promote respiratory exchange
c.Administer O2 at low concentration to maintain respiratory drive
d.Encourage slow, deep breathing with inhalation longer than exhalation to increase intake
390.A client with a 10 year history of emphysema is admitted in acute respiratory distress. The nurses assessment of this client
will include observing for:
a.Pursed lip breathing
b.Use of accessory muscles for respiration
c.Signs and symptoms of respiratory alkalosis
d.Prolonged inspiration with considerable effort
391.A client with a history of Emphysema is in acute respiratory failure with respiratory acidosis. Low level oxygen is
administered by a nasal cannula. Four hours later, the nurse identifies that the client has increased restlessness and
confusion followed by a decreased respiratory rate and lethargy. The nurse could:
a.Increase oxygen by 2% increments
b.Question the client about confusion
c.Percuss and vibrate chest walls
d.Discontinue or decreased oxygen flow rate
392. The nurse is aware that a client understands the instructions about an appropriate breathing technique for chronic
obstructive pulmonary disease when the client:
a.Inhales through the mouth
b.Increases respiratory rate
c.Holds each breath for a second at the end of respiration
d.Progressively increases the length of the inspiratory phase
393.The nurse is teaching the client diaphragmatic breathing. The client should be advised to:
a.Take rapid deep breaths
b.Breath with hands on the hips
c.Expand abdomen on inhalation
d.Perform exercises in the orthopneic position
394.A 21 year old client comes to the emergency department with the chief complaint of left sided chest pain following a
racquetball game. A chest x ray reveals a left pneumothorax. When assessing the left side of the client chest, the nurse
would expect to find
a.A resonant sound on percussion
b.Vocal fremitus on palpation
c.Rales and rhonchi on auscultation
d.An absence of breath sounds on auscultation
395.A client with pneumothorax asks, Why did they put tubes on my chest? The nurse should explain that the purpose of the
chest tube is to
a.Check the bleeding in the lung
b.Monitor the function of the lung
c.Drain fluid from the pleural space
d.Remove air from the pleural space
396.When inspecting a dressing following a partial pneumonectomy for cancer of the lung, the nurse observes some puffiness
of the tissue around the area. When the area is palpated, the tissue feels spongy and crackles. When charting, the nurse
should describe this as

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a.Stridor c. Pitting edema
b.Crepitus d. chest distention
397.When turning a client following right pneumonectomy, the nurse should plan to place the client in either the:
a.Right or left side lying position
b.High fowlers or supine position
c.Supine or right side lying position
d.Left side lying position or low fowlers position
398.After thoracentesis for pleural effusion, a client returns to the physicians office for a follow up visit. The nurse would suspect
a recurrence of pleural effusion when the client says:
a.Lately I can only breathe well when I sit up
b.During the night I sometimes have fever and chills
c.I get a sharp stabbing pain when I take deep breath
d. I am coughing up larger amounts of thicker mucus for the last two days
399. When a client returns for bronchoscopy, the nurse should withhold food and fluid for several hours to prevent
a.Aspiration c. Abdominal distention
b.projectile vomiting d. Dysphasia and dyspepsia
400.During the immediate post op period after laryngectomy, a nursing priority for the client should be to
a.Provide emotional support
b.Observe for signs of infection
c.Keep the trachea free of secretions
d.Promote a means of communication
401.After surgery, the physician orders an incentive spirometer for a client. The nurse would know that the client was using the
spirometer correctly when observing that the client
a.Uses the incentive spirometer for 10 consecutive breaths an hour
b.Coughs twice before inhaling deeply through the mouth piece
c.Inhales deeply, seals the lips around the mouthpiece and exhales
d.Inhales deeply through the mouthpiece hold breath for 2seconds then exhales
402.A 60 year old male is returned to the surgical unit after laryngoscopy . The nurse reminds the client not to take anything by
mouth until instructed to do so. This nursing intervention generally would be considered:
a.Appropriate because these clients usually experience painful swallowing for several days
b.Appropriate because early drinking or eating after the clients laryngoscopy may result in aspiration
c.Inappropriate because the client is not unconscious and maybe thirsty after being NPO
d.Inappropriate because the client is likely to be anxious and probably will not be aware of feeling thirsty
403.A total laryngectomy and radical neck dissection is scheduled for client with cancer of the larynx. When reinforcing the
physicians statements to the client, the nurse should review what the surgery entails and what abilities will be lost. The
discussion also should focus on what abilities will be retained, such as the ability to:
a.Blow the nose c.Chew and swallow food
b.Sip through the straw d.Smell and differentiate odors
404.A client who has had thoracic surgery has a chest tube connected to a water seal drainage system attached to suction.
When excessive bubbling is identified in the water seal chamber, the nurse should
a.Check the system for air leaks
b.Strip the chest tube catheter
c.Decrease the amount of suction pressure
d.Recognize that the system is functioning correctly
405.The nurse recognizes that a client who has had thoracic surgery needs further teaching when the client performs post
thoracotomy exercise by
a.Extending the arm up and back and out to the side and back
b.Climbing a wall with fingers until the arm is fully extended
c.Tying a rope to a door knob and swinging the arm in wide circles
d.Extending the arm out and bringing it up to touch the nose with finger
406.The nurse is instructed to measure and documents the amount of drainage from a clients chest tube. The nurse should
a.Aspirate fluid from the drainage collection chamber of the closed chest drainage system with a needle and syringe and
measure the drainage
b.Connect a new closed chest drainage system, measure the fluid in the drainage collection chamber of the old system and
discard the old system
c.Mark the time and fluid level on the outside of the drainage collection chamber of the closed chest drainage system
d.Clamp the chest tube, empty the fluid from the drainage collection chamber of the closed chest drainage system into a
measuring cup and reconnect the system
407.The nurse in the emergency department has been notified that a person who has sustained a gun shot wound to the right
side of the chest would arrive soon. The nurse should plan to;
a.Reserve an operating room
b.Prepare equipment for tracheostomy
c.Arrange for portable X ray examination
d.Obtain equipment for chest tube insertion
408.A chest tube is inserted after a crushing chest injury. The observation that indicates a desired response to treatment of the
clients chest injury would be
a.Increased breath sounds
b.Increased respiratory rate
c.Crepitus detected on palpation of the chest

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d.Constant bubbling in the drainage collection chamber
409.On the way to X ray examination a client with chest tube becomes confused and pulls the chest tube out. The nurses
immediate action should be to:
a.Place the client in Trendeleburg position
b.Hold the insertion site open with Kelly clamp
c.Obtain sterile Vaseline gauze to cover the opening
d.Cover the opening with the cleanest material available
410.A client has chest tube for a pneumothorax. The nurse finds the client in respiratory difficulty with the chest tube separated
from the drainage system. The nurse should:
a.Obtain new sterile drainage system
b.Clamp the drainage tubing with two clamps
c.Reconnect the clients tube to the drainage system
d.Place the client in high Fowlers position immediately
411. To promote continued improvement in a clients respiratory status after a chest tube is removed, the nurse should:
a.Continue observing for dyspnea and crepitus
b.Encourage frequent coughing and deep breathing
c.Remind the client to turn from side to side at least every 2 hours
d.Encourage bed rest with active and passive range of motion exercise
412.Ventricular repolarization is seen on ECG as
a.QRS complex b.T wave c. P wave d. P R interval
413.Vertical lines in the ECG determines
a.Time of cardiac action potential
b.Amplitude of cardiac action potential
c.Strength of impulse conduction from SA node
d.Number of beats per minute
414. Disorders seen on ECG include the following, except
a.Dysrhthmias c. Electrolyte imbalance
b.Myocardial damage d. Valvular defect
415.A 2 g sodium diet is prescribed for a client with severe hypertension. The client does not like the diet and the nurse hears
the client tell a friend to bring in some good home-cooked food it would be most effective for the nurse to plan to:
a.Call in the dietitian for client teaching
b.Wait for the clients family & discuss the diet with the client & the family
c.Tell the client that the use of salt is forbidden because it will raise the BP
d.Catch the family members before they go into the clients room & tell them about the diet
416.A client states that the anginal pain increases after activity. The nurse should realize that angina pectoris is a sign of
a.Mitral insufficiency c. Myocardial infarction
b.Myocardial ischemia d. Coronary thrombosis
417.Nitroglycerin SL is prescribed for anginal pain. When teaching how to use nitroglycerin, the nurse tells the client to place 1
tablet under the tongue when pain occurs and to repeat the dose in 5 minutes if pain persists. The nurse should also tell the
client to:
a.Place 2 tablets under the tongue when intense pain occurs
b.Swallow 1 tablet and place 1 tablet under the tongue when pain is intense
c.Place 1 tablet under the tongue 3 minutes before activity and repeat the dose in 5 minutes if pain occurs
d.Place 1 tablet under the tongue when pain occurs and use an additional tablet after the attack to prevent recurrence
418.Cholesterol, frequently discussed in relation to atherosclerosis, is a substance that
a.May be controlled entirely by eliminating food sources
b.Is found in many foods, both plant and animal sources
c.All person would be better off without because it causes the disease process
d.Circulates in the blood, the level of which responds usually to dietary substitutions of unsaturated fats for saturated fats
419.The nurse in the coronary care unit (CCU) should observe for one of the more common complications of myocardial
infarction, which is
a.Hypokalemia c. Cardiac dysrrhythmia
b.Anaphylactic shock d. Cardiac enlargement
420.The laboratory tests the nurse would expect the physician to order to confirm a diagnosis of myocardial infarction would
include
a.LDH, CK-MB, AST c. ESR, ALT
b.Serum Calcium, APPT d. Serum potassium
421.During the acute phase of following myocardial infarction, the nurse should make the client bed by
a.Changing the top linen & only necessary the bottom linen
b.Changing the linen from top to bottom without lowering the head of the bed
c.Lifting rather than rolling the client from side to side while changing the linen
d.Sliding the client onto a stretcher, remaking the bed, then sliding the client back to the bed
422.A client is receiving digoxin (Lanoxin) and will continue taking the drug after discharge. The nurse should be primarily
concerned with
a.Monitoring vital signs & encouraging gradual increase in activities of daily living
b.Taking the apical pulse before drug administration and teaching the client how to count the pulse rate
c.Observing the client for return of normal cardiac conduction patterns & for adverse effects of drugs
d.Assessing the client for changes in cardiac rhythm and planning activity at home based tolerance
423.When a client is receiving anticoagulants, the nursing care should include observation for:

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a.Nausea b.Epistaxis c.Headache d.Chest pain
424.While a pacemaker catheter is being inserted, the clients heart rate drops to 38. The drug the nurse should expect the
physician to order is
a.Atropine sulfate c. Lidocaine (Xylocaine)
b.igoxin (lanoxin) d. Procainamide
425.The nurse would prioritize care and provide treatment first for client with:
a.Head injuries c. Ventricular fibrillation
b.A fractured femur d. A penetrating abdominal wound
426.When ventricular fibrillation occurs in a coronary care unit, the first person reaching the client should:
a.Administer oxygen
b.Defibrillate the patient
c.Initiate cardiopulmonary resuscitation
d.Administer sodium bicarbonate intravenously
427.During the cardiac arrest, the nurse and the arrest team must keep in mind the
a.Age of the client
b.Time the client is anoxic
c.Emergency medications available
d.Heart rate of the client before the arrest
428.A client who has collapsed has no carotid pulse on respirations. The nurse should:
a.Initiate a code
b.Check the radial pulse
c.Give four full lung inflation
d.Compress the lower sternum 15 times
429.A client has edema during the day and it disappears at night. The client states it is not painful and is located in the lower
extremities. The nurse should suspect
a.Lung disease c. Myocardial infarction
b.Pulmonary edema d. Right ventricular failure
430.The nurse can best assess the degree of edema in an extremity by
a.Weighing the client c. Measuring the affected area
b.hecking the pitting d. Observing input & output
431.The nurse should realize that the client with right ventricular heart failure may develop ascites because of
a.Loss of cellular constituents of the blood
b.Rapid osmosis from tissue spaces to cells
c.Increased pressure within the circulatory system
d.Rapid diffusion of solutes and solvents into the plasma
432.When assessing clients with the following medical problems, the nurse would expect pulmonary edema to be associated
with
a.Mitral stenosis
b.Pulmonary valve stenosis
c.Severe arteriosclerosis of the coronary arteries
d.Calcification and incomplete closure of the tricuspid valve
433.The nurse attempts to allay the anxiety of a client with congestive heart failure because restlessness
a.Increases cardiac workload
b.Interfere with normal respirations
c.Produces an elevation of temperature
d.Decreases the amount of oxygen available
434.To help alleviate the distress of a client with congestive heart failure and pulmonary edema, the nurse should
a.Elevated the lower extremities
b.Encourage frequent coughing
c.Prepare modified postural drainage
d.Place the client in an orthopneic position
435.In general, the higher the red blood cell count
a.The higher the blood pH
b.The lower the hematocrit
c.The greater the blood viscosity
d.The less it contributes to the immunity
Situation: Karlotte Manasan was having chest pain. He was rushed to the hospital emergency room and was diagnosed of
angina pectoris
436.The best drug to be administered to relieve chest pain is

a.Morphine sulfate c. ACE inhibitors
b.Nitroglycerine d.B-blockers
437.The definitive diagnostic procedure for angina pectoris is
a.Echocardiogram c. Chest x-ray
b.ECG d. Cardiac catheterization
438.Cardiac enzymes that would least likely help in the diagnosis
a.CK-MB c. SGOT
b.LDH d. Alkaline phosphatase

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439.This ECG finding is expected to be seen in angina pectoris
a.T wave inversion c. U wave
b.Widened QRS d.. Prolong PR interval
440.A nurse evaluates a patient after pericardiocentesis for cardiac tamponade. Which of the following observations would
indicate that the procedure was unsuccessful?
a.Rising central venous pressure
b.Rising blood pressure
c.Clients expression of relief
d.Clearly audible heart sounds
441.The most important long-term goal for a client with hypertension would be:
a.Learn how to avoid stress
b.Make commitment to long term therapy
c.Explore a job change
d.Control high blood pressure
442.A client receives a thrombolytic agent. The expected outcome of this drug therapy includes:
a.improves cerebral perfusion
b.Dissolve emboli
c.Decrease vascular permeability
d.Prevention of further cerebral hemorrhage
443.Which of the following statements, if made by a patient who is suspected of having congested heart disease, would support
the diagnosis?
a.I sleep using two pillows
b.My ears have a ringing sensation
c.My weight gone down
d.I am not able to tolerate it
444.Which of this statement, if made by a patient who has a prescription for sublingual nitroglycerine tablets, would indicate a
correct understanding of the medication instruction?
a. I should take the pills with a full glass of water
b.I should protect these pills from sunlight
c.I should wait 30 minutes before taking the second pill
d.I should chew the pill for faster effect
445.Which of the following laboratory results would a nurse check before administering digoxin (Lanoxin) to a patient?
a.Urinalysis c. Urine ketones
b.Blood glucose d. Serum potassium
446.Which of the following conditions would a nurse expect when assessing a patient who has right sided heart failure?
a.shortness of breath c.. peripheral edema
b.decreased urinary output d. paroxysmal nocturnal dyspnea
447.Which of the following factors, if noted in patient history indicates a predisposition to the development of endocarditis?
a.crowded living conditions c. multiple sex partners
b.intravenous drug use d.. family history of heart disease
448.A patient who has diagnosis of valvular heart disease received discharge instruction from a nurse. Which of the following
statements, if made by a patient, would indicate correct understanding of the discharge teaching?
aI will need to wear a Holter monitor to determine how well I am doing
bI will have to take antibiotics for the rest of my life
cI will have to avoid going out in the crowded places
dI will have to inform my dentist of my condition before treatment
449.The patient has a history of long standing hypertension. The primary organ being affected by hypertension is
a.Lungs b. Heart c. Kidneys d. Brain
450.Since the patient was prescribed anti hypertensive medications, he should be cautioned to:
a.Take hot baths only
b.Move slowly from standing position
c.Avoid standing motionless for a long time
d.Stop driving motor vehicles
451.Vasodilators may be prescribed to this patient. The following dilate vessels, except
a.Nitrates c. Calcium channel blockers
b.ACE inhibitors d. Ergotamia
452.An alpha 1 antagonist that block sympathetic response to the blood vessels may also be used for hypertension because
a.It causes decrease HR and cardiac contractility
b.It causes vasodilation
c.It increases the preload
d.All of the above
453.Pharmacologic management of chest pain in pericarditis is
a.Morphine c. Ibuprofen
b.Nitroglycerine d. All of the above
454.The most characteristic sign of pericarditis is
a.Chest pain c. Friction rub
b.Fever d. Increased ESR
455.Cardiac tamponade may result to
a.Decreased venous return c. Both

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b.Decreased cardiac output d. Neither
456.The most common for of cardiomyopathy
a.Dilated Cardiomyopathy
b.Hypertrophic cardiomyopathy
c.Restrictive cardiomyopathy
d.Arrythmogenic right ventricular cardiomyopathy
457.Major goals in the management of cardiomyopathy include
a.Increased activity tolerance
b.Increased sense of power with decision making
c.Reduction of anxiety
d.All of the above
458.You are caring for a man with pericariditis, His systolic pressure begins to fall and heart sounds cannot be heard. Nurse
would
a.Do pericardiocentesis
b.Refer to physician
c.Monitor BP again after 15 minutes
d.Scream
459.The hearts pacemaker or sinoauricular node is located
a.at the base of the right atrial septum
b.in the upper part of the right atrium
c.at the entrance of the right ventricle
d.in the anterior left atrium
460.The electrical waves which represent the QRS complex occur when the
a.ventricles contract c. ventricles relax
b.atria contract d. atria relax
461.The electrical impulses which demonstrate atrial depolarization is the
a.P wave c. PR interval
b.T wave d. QRS complex
462.Hypertension is defined as persistently elevated systolic and diastolic pressure above
a.200/80 c. 140/90
b.170/90 d. 170/100
463.A client is scheduled for Barium swallow. The nurse should
a.Ask the client about allergies to iodine
b.Ensure a laxative is ordered after the test
c.Give only clear fluids on the day of the test
d.Administer cleansing enema before the test.
464.A client should be instructed to avoid straining on defecation to prevent bleeding after pelvic surgery. The nurse is aware
that the related teaching has been understood when the client states, I must increase my intake of
a.Ripe bananas c. Green vegetables
b.Milk products d. Creamed potatoes
465.The physician orders three stool specimens for occult blood from a client who complains of blood streaked stools and a 10
pound weight loss in one month. To ensure the validity of the test results, the nurse instructs the client to
a.Avoid eating red meat before the test
b.Test the specimen while it is still warm
c.Discard the first stool of the day and use the next three stools
d.Take three specimens from different section of fecal samples
466.When a client develops steatorrhea, the nurse should describe the stool as
a.Dry and rock hard c. Bulky and foul smelling
b.Clay colored and pastry d. Black and blood streaked
467.The physician orders total parenteral nutrition TPN 1 liter every 12 hours. The primary nursing responsibility should be to
monitor the clients
a.Electrolytes c. Administration rate
b.Urinary output d. Serum glucose levels
468.The nurse should teach the client with gastroesophageal reflux disease that after meals the client should
a.Take a short walk
b.Drink 8 oz of water
c.Lie down at least 20 minutes
d.Rest in a sitting position for one half hour
469.A 54 year old obese bachelor arrives at the clinic complaining of epigastric distress and esophageal burning. During the
health history, he admits to binge drinking and frequent bronchitis, after diagnostic studies, a diagnosis of hiatus hernia is
made. The health problem that would most likely contributed to the development of hiatus hernia would be
a.Obesity c. Esophagitis
b.Bronchitis d. Alcoholism
470.A male client is diagnosed with acute gastritis secondary to alcoholism and cirrhosis. When obtaining this client history, the
nurse should give priority to the clients statement that
a.His pain is increased after meals
b.He experience nausea frequently
c.His stools have tarry appearance
d.He recently joined alcoholic anonymous

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471.An adaptation after gastroscopy that indicate a major complication would be
a.Increased GI motility c. Nausea and vomiting
b.Difficulty swallowing d. Abdominal distention
472.A traveling salesman develops gastric bleeding and is hospitalized. An important etiologic clue for the nurse to explore while
taking this clients history would be
a.Any recent foreign travel
b.The clients usual dietary problem
c.Any change in the status of the family
d.The medications that the client has been taking
473.After an acute episode of upper GI bleeding, a client vomits undigested antacids and complains of severe epigastric pain.
The nursing assessment reveals an absence bowel sounds, pulse rate of 134, and shallow respiration of 32 per minute. In
addition to calling the physician, the nurse should:
a.Keep the client NPO in preparation for surgery
b.Start O2 per cannula 3 to 4L per minute
c.Place the client in supine position with legs elevated
d.Ask the client whether any red or black stools have been noticed
474.Following subtotal gastrectomy, a client begins to eat more food in varied forms. After meals the client experiences
cramping discomfort and a rapid pulse with waves of weakness which are often followed by nausea and vomiting. The
nurse recognizes that this response is known as the dumping syndrome which is caused by
a.A sluggish passage of food dumping into the small intestines
b.Rapid passage of dilute food mixture into the small intestine
c.Sudden passage of hyperosmolar food solution into the small intestine
d.Passage of food that is less concentrated than surrounding extracellular fluid into the small intestine
475.A client is diagnosed with cancer of the stomach and is scheduled for partial gastrectomy. Preoperative preparation for this
client should include an explanation about the postoperative:
a.Gastric suction c. Fluid restriction
b.Oxygen therapy d. Urinary catheter
476.A client with gastric cancer asks whether this cancer will spread. The nurse recognizes the client is looking for reassurance
but knows gastric cancers are most likely to metastasize to the
a.Liver and lung c. Pancreas and brain
b.Bone and brain d. Lymph nodes and blood
477.Twelve hours after subtotal gastrectomy, the nurse notes large amounts of bloody drainage from the clients nasogastric
tube. The nurse should:
a.Instill 30 ml of iced normal saline into the tube
b.Clamp the tube and call the physician immediately
c.Report the type and quantity of drainage to the physician
d.Continue to monitor drainage and record observations
478.The nurse should assess for the development of pernicious anemia when a client has a history of
a.Hemorrhage c. Poor dietary habits
b.Diabetes mellitus d. Having had gastrectomy
479.When teaching a client how to avoid dumping syndrome following gastrectomy, the nurse should emphasize:
a.Increasing activity after eating
b.Avoiding excess fluid with meals
c.Eating heavy meals to delay emptying
d.Providing carbohydrates with each meal
480.Immediately after subtotal gastrectomy a client is brought to the post anesthesia care unit. The nurse identifies small blood
clots in the gastric drainage. The nurse should
a.Clamp the tube
b.Consider this normal event
c.Instill the tube with iced saline
d.Notify the physician of this finding
481.On the third post op day after subtotal gastrectomy, a client complains of severe abdominal pain. The nurse palpates the
clients abdomen and notes rigidity. The nurse should first:
a.Assist the client to ambulate
b.Assess the clients vital signs
c.Administer prescribed analgesic
d.Encourage the use of spirometer
482.A client is having surgery for cholecystectomy and common bile duct exploration. The nurse understands that after surgery
the client will
a.Need to take oral bile salts
b.Be unable to concentrate bile
c.Be incapable of producing bile
d.Not be able to digest fatty food
483.A client undergoes an abdominal cholecystectomy with common duct exploration. In immediate post op period, the nursing
action that should assume the highest priority for this client is
a.Irrigating the T tube frequently
b.Changing the dressing BID
c.Encouraging deep breathing and coughing
d.Promoting an adequate fluid intake by mouth

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484.A 40 year old client is admitted with biliary cancer. The associated jaundice gets progressively worse. The nurse should be
most concerned about the potential complication of
a.Pruritus c. Flatulence
b.Bleeding d. Hypokalemia
485.After a cholecystectomy to remove cancerous gall bladder, the client has T tube in place that has drained 300 ml of bile
colored fluid during the first 24 hours. The nurse should
a.Increase fluid intake to compensate for this loss
b.Clamp the tube intermittently to slow drainage
c.Consider this an expected response after surgery and record the results
d.Empty the portable drainage system and re establish negative pressure
486.An obese client with history of gallstones has an abdominal cholecystectomy. After surgery the nurse plans to alleviate
tension on the surgical wound by
a.Limiting deep breathing
b.Maintaining T tube patency
c.Maintaining nasogastric tube patency
d.Encouraging the right side lying position
487.Because of prolonged bile drainage from T tube, a client may develop symptoms related to a lack of fat soluble vitamin such
as:
a.Easy bruising c. Excessive jaundice
b.Muscle twitching d. Tingling of the fingers
488.The nurse is aware that the laboratory testy result that most likely would indicate acute pancreatitis is an elevated
a.Blood glucose levels c. Serum bilirubin level
b.Serum amylase level d. White blood cell count
489.A 50 year old farmer is admitted to the hospital with severe back and abdominal pain, nausea and occasional vomiting and
an oral temperature of 37.9 degrees C. He reports drinking six to eight beers a day. A diagnosis of acute pancreatitis is
made. Based on data presented, the nursing diagnosis that is of primary concern for this client would be
a.Disturbed self concept related to illness
b.Acute pain related to inflammation of the pancreas
c.Deficient fluid volume related to inadequate fluid intake
d.Imbalanced nutrition less than body requirements related to vomiting
490.As a clients symptoms of pancreatitis subside, it is most important that the nurse instruct the client to
a.Avoid eating hot spicy food
b.Avoid ingesting alcoholic beverages
c.Eat a bland diet with 6 meals a day
d.Eat a high carbohydrate, low fat, low protein diet
491.A client with ascites is scheduled for paracentesis. To prepare the client for abdominal paracentesis the nurse should:
a.Medicate the client for pain
b.Encourage the client to drink fluids
c.Shave and prep the clients abdomen
d.Instruct the client to empty the bladder
492.When preparing a client for liver biopsy, the nurse explains that during the test the client will be placed:
a.On the right side, with the left arm stretched up over the head
b.In the prone position, with both arms extended over head
c.On the left side with the right side extended out in front of the bed
d.In a dorsal recumbent position, with the right arm raised and behind the head
493.When discussing a scheduled liver biopsy with a client, the nurse should explain that for several hours after biopsy, the
client will have to remain in:
a.The left side lying position with the head of the bed elevated
b.A high fowlers position with both arms supported on pillows
c.The right side lying position with pillows placed under the costal margin
d.Any comfortable recumbent position as long as the client remains immobile
494.The serum ammonia level of a client with hepatic cirrhosis and ascites is elevated. The priority nursing intervention should
be to:
a.Weigh the client daily
b.Restrict the clients intake of fluid
c.Measure the clients urine specific gravity
d.Observe the client for increasing confusion
495.A client with long history of alcohol abuse is admitted to the hospital with ascites, jaundice and confusion. A diagnosis of
hepatic cirrhosis is made; a nursing priority would be to:
a.Institute safety measures c.Measure abdominal girth daily
b.Monitor respiratory status d.Test stool specimen for blood
496.A client with history of gastrointestinal varices develops severe hematemesis and the physician inserts a Sengstaken -
Blakemore tube. The nurse is aware that this tube is a
a.Single lumen tube for gastric lavage
b.Double lumen tube for intestinal decompression
c.Triple lumen tube used to compress the esophagus
d.Multi lumen tube for gastric and intestinal decompression
497.One month after abdominal surgery a client is readmitted to the hospital with recurrent abdominal pain and fever. The
diagnosis is fistula formation with peritonitis. The nurse should place the client in the:

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a.Supine position c. Semi fowlers position
b.Right sims position d. Position that is most comfortable
498.The nurse is performing a physical assessment of a client with ulcerative colitis. The finding most often associated with a
serious complication of this disorder would be:
a.Decreased bowel sounds
b.Loose, blood tinged stools
c.Distention of the abdomen
d.Intense abdominal discomfort
499.A client with colitis inquires as to whether surgery will be necessary. When teaching about the disease and its treatment, the
nurse should emphasize that:
a.Surgery for colitis is considered only as a last resort for most clients
b.Medical treatment for colitis is curative and surgery is not required
c.Surgery for colitis is done early in the course of the disease for most patients
d.Medical treatment is all that will be needed if the client can acquire some emotional stability
500.When caring for a client who has had abdominal intestinal surgery, it is important for the nurse to remember that:
a. Air swallowing can cause gastric dilation
b.Preoperative enemas prevent post op ileus
c.Rectal intubation will relieve nausea and vomiting
d.Clear liquids within 24hours after surgery stimulate persitalsis

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Medical-Surgical Nursing Practice Test

December 2010 N.L.E.

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436.The best drug to be administered to relieve chest pain is

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