PREPARED BY: BURAKDAY, RN

1. The client, an 18-year-old female, 5_4 tall,

weighing 113 kg, comes to the clinic for a
wound on her lower leg that has not healed

for the last two (2) weeks. Which disease
process would the nurse suspect that the
client has developed?
a. Type 1 diabetes
b. Gestational diabetes.
c. Type 2 diabetes
d. Acanthosis nigricans.
2. The client diagnosed with Type 1 diabetes
has a glycosylated hemoglobin (A1c) of 8.1%.
Which interpretation should the nurse make
based on this result?
a. This result is below normal levels.
b. This result is within acceptable levels.
c. This result is above recommended levels.
d. This result is dangerously high.
3. The client diagnosed with HHNS was
admitted yesterday with a blood glucose level
of 780 mg/dL. The client’s blood glucose level

is now 300 mg/dL. Which intervention should
the nurse implement?
a. Increase the regular insulin IV drip.
b. Check the client’s urine for urinary
ketones.
c. Provide the client with a therapeutic
diabetic meal.
d. Notify the physician to obtain an order
to decrease insulin therapy.
4. The nursing assistant on the medical floor tells
the primary nurse that the client diagnosed with
DKA wants something else to eat for lunch.

What action should the nurse implement?
a. Instruct the assistant to get the client
additional food.
b. Notify the dietician about the client’s
request.
c. Ask the assistant to obtain a glucometer
reading.
d. Tell the assistant that the client cannot have
anything else.
5. The nurse is admitting a client diagnosed
with primary adrenal cortex insufficiency
(Addison’s disease). When assessing the

client, which clinical manifestations would
the nurse expect to find?
a. Moon face, buffalo hump, and
hyperglycemia.
b. Hirsutism, fever, and irritability.
c. Bronze pigmentation, hypotension, and
anorexia.
d. Tachycardia, bulging eyes, and goiter.
6. The nurse is developing a plan of care for
the client diagnosed with acquired
immunodeficiency syndrome (AIDS) who has

developed an infection in the adrenal gland.
Which problem would have the highest
priority?
a. Altered body image
b. Impaired coping.
c. Activity intolerance
d. Fluid volume deficit
7. The nurse is planning the care of a client
diagnosed with Addison’s disease. Which
interventions should be included?

a. Administer steroid medications.
b. Place the client on fluid restriction.
c. Provide frequent stimulation.
d. Consult physical therapy for gait training
8. The client diagnosed with a pituitary tumor
has developed syndrome of inappropriate
antidiuretic hormone (SIADH). Which

interventions would the nurse implement?
a. Assess for dehydration and monitor
blood glucose levels.
b. Assess for nausea and vomiting and
weigh daily.
c. Monitor potassium levels and encourage
fluid intake.
d. Administer vasopressin IV and conduct a
fluid deprivation test.
9. The nurse is caring for a client diagnosed
with diabetes insipidus (DI). Which nursing
intervention should be implemented?

a. Monitor blood glucoses before meals and
at bedtime.
b. Restrict caffeinated beverages.
c. Check urine ketones if blood glucose is
> 250.
d. Assess tissue turgor every four (4) hours.
10. The client is diagnosed with
hypothyroidism. Which signs/symptoms
would the nurse expect the client to exhibit?

a. Complaints of extreme fatigue and hair
loss.
b. Exophthalmos and complaints of
nervousness.
c. Complaints of profuse sweating and
flushed skin.
d. Tetany and complaints of stiffness of the
hands.
11. The nurse identifies the client problem
“risk for imbalanced body temperature” for
the client diagnosed with hypothyroidism.

Which intervention would be included in the
client problem?
a. Encourage the use of an electric blanket.
b. Protect from exposure to cold and drafts.
c. Keep the room temperature cool.
d. Space activities to promote rest.
12. The client diagnosed with hypothyroidism
is prescribed the thyroid hormone
levothyroxine (Synthroid). Which assessment

data indicate the medication has been
effective?
a. The client has a three (3)-pound weight
gain.
b. The client has a decreased pulse rate.
c. The client’s temperature is WNL.
d. The client denies any diaphoresis.
13. Which medication order would the nurse
question in the client diagnosed with
untreated hypothyroidism?

a. Thyroid hormones
b. Oxygen
c. Sedatives
d. Laxatives
14. Which statement made by the client would
make the nurse suspect that the client is
experiencing hyperthyroidism?

a. “I just don’t seem to have any appetite
anymore.”
b. “I have a bowel movement about every 3
to 4 days.”
c. “My skin is really becoming dry and
coarse.”
d. “I have noticed that all my collars are
getting tighter.”
15. Which sign/symptom would indicate to
the nurse that the client is experiencing
hyperparathyroidism?

a. A negative Trousseau’s sign.
b. A positive Chvostek’s sign.
c. Nocturnal muscle cramps.
d. Tented skin turgor.
16. Which information is a risk factor for
developing pheochromocytoma?
a. A history of skin cancer.

b. A history of high blood pressure.
c. A family history of adrenal tumors.
d. A family history of migraine
headaches.
17. Which client history would be most
significant in the development of symptoms
for a client who has iatrogenic Cushing’s
disease? 
a. Long-term use of anabolic steroids.
b. Extended use of inhaled steroids for
asthma.
c. History of long-term glucocorticoid use.
d. Family history of increased cortisol
production.
18. The client is one (1) hour postoperative
thyroidectomy. Which intervention should
the nurse implement?

a. Check the posterior neck for bleeding.
b. Assess the client for the Chvostek’s sign.
c. Monitor the client’s serum calcium level.
d. Change the client’s surgical dressing.
19. An independent nursing action that
should be included in the plan of care for a
client after an episode of ketoacidosis is:

a. Observing for signs of hypoglycemia as a
result of treatment
b. Withholding glucose in any form until
the ketoacidosis is corrected
c. Regulating insulin dosage according to
the amount of ketones found in the urine
d. Giving fruit juices, broth, and milk as
soon as the client is able to take fluids
orally
20. To understand diabetes insipidus, the
nurse must be aware that an antidiuretic
substance important for maintaining fluid

balance is released by the:
a. adrenal cortex
b. anterior pituitary
c. adrenal medulla
d. posterior pituitary
21. The two interbalanced regulatory agents
that control overall calcium balance in the
body are:

a. Phosphorus and ACTH
b. Vitamin A and thyroid hormone
c. Ascorbic acid and growth hormone
d. Vitamin D and parathyroid hormone
22. The hormone that tends to decrease
calcium concentration in the blood is:
a. Calcitonin
b. thyroid hormone

c. aldosterone
d. parathyroid hormone
23. The nursing action that should be
included to Mr. Jackson diagnosed of
diabetes insipidus is:

a. Provision of a high – calcium diet
b. assurance of a large fluid intake
c. institution of seizure precaution
d. maintenance of absolute bed rest
Situation: Julia McNeer has been diagnosed as
having Graves’ disease. Radioactive iodine is
prescribed to decrease the activity of the

thyroid, but this therapy is unsuccessful. She is
scheduled for a thyroidectomy.
24. The most appropriate diet for Mrs.
McNeer after surgery would be:
a. Soft
b. low sodium
c. high calorie
d. high roughage
25. The nurse, recognizing the need to
decrease the size and vascularity of the
thyroid gland prior to a thyroidectomy, would

expect the physician to order:
a. propylthiouracil
b. lugol’s iodine solution
c. potassium permanganate
d. liothyronine sodium (Cytomel)
26. When preparing for Mrs. McNeer’s return
after surgery, the nurse should give priority to
having available:
a. Sandbags 
b. tracheotomy tray
c. hemostats
d. nasogastric suction
27. Which of the following is a function of
ADH?
a. Sodium absorption and potassium
excretion 
b. Water reabsorption and urine
concentration
c. Water reabsorption and urine dilution
d. Sodium reabsorption and potassium
retention
28. Which of the following disorders is
suggested by polydipsia and polyuria with
urine specific gravity of 1.002?

a. Diabetes Mellitus
b. Diabetic Ketoacidosis
c. Diabetes insipidus
d. Syndrome of Inappropriate ADH
secretion
29. Which of the following is TRUE with
regards to Insulin absorption?
a. The fastest absorption occurs in the

subcutaneous tissues of the arm
b. The nurse should rotate the injection site
to prevent subcutaneous tissue irritation
c. Insulin are administered directly from
the refrigerator
d. Insulin injections are carefully spaced
apart at least an inch away from one
another
30. The nurse is performing health education
activities for Mandy Lorraine, a 30 year old
dentist with Insulin Dependent Diabetes

Mellitus. Mandy complains of nausea,
vomiting, diaphoresis and headache. Which
of the following nursing intervention are you
going to carry out first?
a. Withhold the client’s next insulin
injection
b. Test the client’s blood glucose level
c. Administer Tylenol as ordered
d. Offer fruit juice and gelatin
31. Lorraine is preparing a mixed dose of
insulin. The nurse is satisfied with her
performance when she:

a. Draw insulin from the vial of clear insulin
first
b. Draw insulin from the vial of intermediate
acting insulin first.
c. Fill both syringes with the prescribed
insulin dosage then shake the bottle
vigorously.
d. Withdraw the intermediate acting insulin
first before withdrawing the short acting
insulin
32. A nurse is reviewing home care instructions with
an elderly client who has type 1 DM and a history of
diabetic ketoacidosis. The client’s spouse is present


when the instructions are given. Which of the
following statements, if made by the spouse, indicates
that further teaching is necessary?
a. “If the grandchildren are sick they probably
shouldn’t come to visit.”
b. “I should call the doctor if he has nausea and/ or
abdominal pain lasting for more than 1 to 2
days.”
c. “If he is vomiting I shouldn’t give him any
insulin.”
d. “I should bring him to the physician if he
develops cough.”
33. A client with DM has received instructions
about foot care. Which of the following
statements would indicate that the client

needs further instruction?
a. “The best time to cut my nails is after
bathing.”
b. “Cotton stocking should be worn to
absorb excess moisture.”
c. “The cuticles of my nails should be cut to
prevent overgrowth.”
d. “My feet should be inspected daily using
a mirror.”
34. Mrs. Batumbakal was diagnosed with
hyperthyroidism. As her nurse, you should be
able to assess, diagnose, plan, intervene and

evaluate her response to this physiologic
alteration. After thyroidectomy, the nurse notes
that calcium gluconate is prescribed for the
client. He knows that this medication is needed
to:
a. Prevent cardiac irritability
b. Treat thyroid storm
c. Stimulate the release of parathyroid
hormone
d. Treat hypocalcemic tetany
35. Mrs. Batumbakal is worried because after
thyroidectomy, she developed voice
hoarseness. She asked if the hoarseness will

subside. You correctly tell her that hoarseness:
a. Indicates nerve damage
b. Is permanent
c. Is temporary
d. Is a complication and warrants further
assessment by the physician
36. As the nurse, you should anticipate to
administer which of the following
medications to Zach who is diagnosed to be

suffering from hypothyroidism?
a. Levothyroxine
b. Lidocaine
c. Lipitor
d. Levophed
37. Your appropriate nursing diagnosis for
Zach who is suffering from hypothyroidism
would probably include which of the
following? 
a. Activity intolerance related to tiredness
associated with disorder
b. Risk to injury related to incomplete
eyelid closure
c. Imbalance nutrition related to
hypermetabolism
d. Deficient fluid volume related to
diarrhea
38. As a nurse, you know that the most
common type of goiter is related to a
deficiency of:
a. Thyroxine

b. Thyrotropin
c. Iron
d. Iodine
39. Loewy, sought consultation to the hospital
because of fatigability, irritability, jittery, and
he has been experiencing this signs and

symptoms for the past 5 months. His
diagnosis was hyperthyroidism, the following
are expected symptoms except:
a. Anorexia
b. Fine tremors of the hand
c. Palpitation
d. Hyper alertness
40. A nurse assesses the client with a diagnosis
of thyroid storm. Which of the following
classic signs and symptoms associated with

thyroid storm would indicate the need for
immediate nursing intervention?
a. Fever, Tachycardia, and systolic
hypertension
b. Polyuria, nausea, and severe headaches
c. Profuse diaphoresis, flushing and
constipation
d. Hypotension, translucent skin and obesity
41. Hyperphosphatemia and Hypocalcemia
are indicative of which following
disorders?

a. Hypoparathyroidism
b. Hypothyroidism
c. Cushing’s syndrome
d. Grave’s Disease
42. The nurse is caring for a client in
Addisonian crisis. Which laboratory
finding would the nurse expect to find?
a. Hyperkalemia

b. Hyperglycemia
c. Hypernatremia
d. 80mg/dl blood glucose
43. The adrenal cortex is responsible for
producing:
a. Cortisol and aldosterone

b. Glucocorticoids and glucagons
c. Mineralocorticoids and
catecholamines
d. Norepinephrine and epinephrine
44. A client is seen in the health care clinic,
and a diagnosis of hypothyroidism is
suspected. Which of the following findings
 to note in the
would the nurse expects
client?
a. Bradycardia
b. Profuse diaphoresis
c. Exophthalmos
d. Hyperactivity
45. A client 42 years old has a tentative
diagnosis of hyperthyroidism. During
assessment of the client, the nurse would

expect which of the following complains?
a. Loss of appetite and abnormal
pigmentation
b. Insomnia and palpitations
c. Polyuria and excessive thirst
d. Diaphoresis and disorientation
46. The family of a client with myxedema is extremely
distressed about how the disease is affecting the client’s
intellectual functions such as impaired memory,
inattentiveness, and lethargy. Which of the following

statements would be most appropriate for the nurse to
make?
a. “It sounds as though the disease is in the advanced
stage and unfortunately the symptoms are
irreversible.”
b. “Try not to worry! I’ve taken care of similar clients
before, and most of them do well.”
c. “I can see that you are concerned, but these
symptoms are normal with myxedema and should
improve with therapy.”
d. “Would you like me to let the physician know about
this so a tranquilizer can be prescribed?”
47. He has to take drugs to treat her
hyperthyroidism. Which of the following
will you NOT expect that the doctor will
prescribe? 
a. Colace (Docusate)
b. Tapazole (Methimazole)
c. Cytomel (Liothyronine)
d. Prophylthiouracil (PTU)
48. Which of the following nursing actions
would be most important when caring for
patients with diabetes insipidus?
a. CBC

b. Fasting finger-stick blood sugars every
morning
c. Passive ROM exercises
d. Hourly urine output measurements
49. Quizea, an 8 year old child, was recently
diagnosed with DM Type 1. A sign that is
frequently seen in pediatrics diagnosed
with DM is: 
a. Irritability
b. Lethargy
c. Bed wetting
d. Polyphagia
50. Clients with DM should be taught that
it is most appropriate to test urine for
acetone:

a. After ingesting a high-fat snack
b. If unable to test blood glucose
c. After unexplanned exercise
d. If experiencing illness
1. After extensive, prolonged surgery it is
most important that the nurse observe the
client for the depletion of the electrolyte:
a. Calcium

b. Potassium
c. Sodium
d. Chloride
2. The most important electrolyte of
extracellular fluid is:
a. Calcium
 c. Potassium
b. Sodium d. Chloride
3. A client is admitted with diarrhea, anorexia,
weight loss and abdominal cramps. A
diagnosis of colitis is made. The symptoms of

fluid and electrolyte imbalance caused by this
condition that the nurse should report
immediately are:
a. Tachycardia and extreme muscle
weakness
b. Diplopia, skin rash and diarrhea
c. Leg and stomach cramps, nausea and
vomiting
d. Development of tetany with muscle
spasms
4. A client is admitted to the hospital for
hypocalcemia. Nursing interventions

relating to which system would have the
highest priority?
a. Cardiac c. Neuromuscular
b. Renal d. Gastrointestinal
5. A client is receiving digoxin (Lanoxin)
and furosemide (Lasix). The client should
be observed for symptoms of electrolyte
depletion caused by;
a. Sodium restriction
b. Continuous dyspnea
c. Inadequate oral intake
d. Diuretic therapy
Situation: A nurse is caring for a client who
arrives at the emergency room with the
emergency medical services team following a

burn injury from an explosion. The client has
sustained thoracic burns and smoke
inhalation. (Nos. 6- 10)
6. A nurse assesses the carbon monoxide level
of a client following a burn injury and notes
that the level is 14%. Based on this level,
which finding would the nurse expect to note
during the assessment of the client?
a. Tachycardia c. Headache
b. Nausea d. Impaired visual acuity
7. The nurse avoids which action in caring
for a client who sustained smoke
inhalation and is at risk for impaired gas
exchange? 
a. Suctioning the airway as needed
b. Repositioning the client from side to
side every 2 hours
c. Providing humidified oxygen as
prescribed
d. Maintaining the client in a supine
position with the head of the bed
elevated
8. Which initial finding would indicate the
presence of inhalation injury?
a. The presence of sputum tinged with

carbon and singed nasal hair
b. Tachycardia
c. Expectoration of sputum tinged with blood
d. Absent breath sounds in the lower lobes
bilaterally
9. A nurse assesses the client’s burn injury
and determines that the client sustained a
partial-thickness superficial burn. Based on

this determination, which finding did the
nurse note?
a. Absence of wound sensation
b. Charring at the wound site
c. A dry wound surface
d. A wet, shiny, weeping wound
10. The patient receives daily doses of
furosemide (Lasix) and digoxin (Lanoxin) for
treatment of heart failure. The patient is more

likely to develop a toxic reaction to digoxin if
he has concurrent:
a. Hyponatremia c. Hypernatremia
b. Hyperkalemia d. Hypokalemia
11. His serum potassium level is 3.1 mEq/L.
Which associated electrocardiogram changes
would you expect?
a. Peaked T wave 
b. Depressed ST segment
c. Narrow QRS complex
d. Absent P waves
12. As part of the patient’s treatment for
hypokalemia, the doctor prescribes IV
potassium supplementation. At which rate

should it be administered?
a. 5 mEq/hour c. 15 mEq/hour
b. 10 mEq/hour d. 20 mEq/hour
13. The patient calls you to her room because
he’s short of breath. You assess him and find
that his heart failure is worsening. Which

type of fluid volume excess is the patient
experiencing because of his heart failure?
a. Intravascular c. Intracellular
b. Extracellular d. Interstitial
14. During the fluid accumulation phase of
a major burn injury, fluid shifts from the:
a. Intravascular space to the interstitial
space

b. Interstitial space to intravascular space
c. Intracellular space to interstitial space
d. Intravascular space to intracellular space
15. You insert an IV line and begin fluid
resuscitation. The doctor wants you to use
the Parkland formula. What amount of
 should you
Lactated Ringer’s solution
administer over the first 8 hours?
a. 700 mL c. 1,400 mL
b. 7,000 mL d. 6,000 mL
16. 48 hours after the burn injury, what
physiologic changes can be expected?
a. Edema development

b. Increased blood volume
c. Decreased hemoglobin level
d. Profuse urination
17. During the fluid remobilization phase,
the nurse would expect to see signs of
which electrolyte imbalance?
a. Hypokalemia
 c. Hypernatremia
b. Hyperkalemia d. Hypovolemia
18. Burn wound sepsis develops and mafenide
acetate 10% (Sulfamylon) is ordered BID. While
applying Sulfamylon to the wound, it is important

for the nurse to prepare the client for expected
responses to the topical application which include
a. Severe burning pain for a few minutes
following application
b. Possible severe metabolic alkalosis with
continued use
c. Black discoloration of everything that comes
in contact with this drug
d. Chilling due to evaporation of solution from
the moistened dressings
19. A client is admitted to the hospital after
sustaining burns to the chest, abdomen, right
arm, and right leg. Using the “rule of nines,”

the nurse would determine that about what
percentage of the client’s body surface has
been burned?
a. 18%
b. 27%
c. 45%
d. 64%
20. The nurse assesses the client for fluid
shifting. Fluid shifts that occur during the
emergent phase of a burn injury are caused by
fluid moving: 
a. From the vascular to the interstitial space
b. From the extracellular to the intracellular
space
c. From the intracellular to the extracellular
space
d. From the interstitial to the vascular space
21. The nurse should recognize that fluid
shift in a client with burn injury results
from an increase in the:

a. Permeability of capillary wash
b. Total volume of intravascular plasma
c. Total volume of circulating whole blood
d. Permeability of the kidney tubules
22. A priority nursing diagnosis for a client
with burns during emergent period would
be
a. Excess Fluid Volume

b. Imbalanced Nutrition: Less than Body
Requirements
c. Risk for Injury (falling)
d. Risk for infection
23. Which of the following activities
should the nurse include in the care plan of
a client with burn injuries to be carried out
about one- half hour before the daily
whirlpool bath and dressing change?
a. Soak the dressing
b. Remove the dressing
c. Administer an analgesic
d. Slit the dressing with blunt scissors
24. Which of the following questions
may lead the nurse to identify a
predisposing factor for
hypomagnesemia?

a. “Are you taking calcium
supplements?”
b. “Do you have diabetes mellitus?”
c. “Do you have any bowel problems?”
d. “Did you have a thyroid surgery
recently?”
25. The physician has ordered 1000ml. TPN in
12 hours to be infused via a subclavian
catheter. When preparing the equipment it

would be most important for the nurse to
obtain:
a. A steady IV pole
b. An infusion pump
c. An infusion set delivering 60gtt/mL
d. A set of clamps (hemostats0 taped at the
bedside
26. A client is to receive an IV solution
containing potassium chloride. When starting
this IV infusion the nurse should select:

a. The antecubital space in the client’s arm
b. The largest possible vein in the client’s arm
c. A vein in the back of the client’s dominant
hand
d. A vein in the back of the clients non-
dominant hand
27. When evaluating a client’s response to
fluid replacement therapy, the observation
that indicates adequate tissue perfusion to
vital organs would be:
a. Urinary output of 30ml per hour
b. Central venous pressure reading of 2cm
H2O
c. Pulse rates of 120 and 110 in a 15-minute
period
d. BP readings of 50/30 and 70/40 mm Hg
within 30 minutes
28. Elimination of excess potassium through
stools is the action of which medication that
will therapeutically treat hyperkalemia is?

A. Calcium gluconate C. Kayeaxelate
B. Insulin and glucose D. Sodium
bicarbonate
29. Which among the following principles of
fluid movement is correctly stated?
A. Osmosis is movement of water from an

area of low to high solutee concentration
B. Diffusion is movement of fluid from an
area of low to high molecular component
C. Active transport is movement of
subtances without energy utilization
D. Filtration is from an area of low
hydrostatic pressure to high hydrostatic
pressure
30. Which among the following types of
intravenous fluid solution/s is considered to
be isotonic?
A. PNSS 
C. PLR
B. D5W D. ALL OF THESE
31. PH 7.57. PaCO2 22. HCO3- 17
a. Respiratory Acidosis. Partially
Compensated

b. Respiratory Alkalosis. Uncompensated
c. Metabolic Acidosis. Partially Compensated
d. Respiratory Alkalosis. Partially
Compensated
32. PH 7.39. PaCO2 44. HCO3- 26
a. Respiratory Acidosis
b. Metabolic Acidosis

c. Respiratory Alkalosis
d. Normal
33. PH 7.55. PaCO2 25. HCO3- 22
a. Respiratory Acidosis. Partially
Compensated

b. Respiratory Alkalosis. Uncompensated
c. Metabolic Alkalosis. Partially
Compensated
d. Metabolic Acidosis. Uncompensated
34. PH 7.17. PaCO2 48. HCO3- 36
a. Respiratory Acidosis. Uncompensated
b. Metabolic Acidosis. Partially Compensated

c. Respiratory Alkalosis. Partially
Compensated
d. Respiratory Acidosis. Partially
Compensated
35. PH 7.34. PaCO2 24. HCO3- 20
a. Respiratory Acidosis. Partially
Compensated

b. Metabolic Acidosis. Partially Compensated
c. Metabolic Acidosis. Uncompensated
d. Metabolic Alkalosis. Partially
Compensated
36. PH 7.64. PaCO2 25. HCO3- 19
a. Respiratory Acidosis. Uncompensated
b. Respiratory Alkalosis. Partially
Compensated

c. Respiratory Alkalosis. Uncompensated
d. Metabolic Alkalosis. Partially
Compensated
37. PH 7.45. PaCO2 50. HCO3- 30
a. Metabolic Alkalosis. Fully Compensated
b. Respiratory Alkalosis. Fully Compensated

c. Metabolic Alkalosis. Partially
Compensated
d. Respiratory Acidosis. Partially
Compensated
38. PH 7.6. PaCO2 53. HCO3- 38
a. Metabolic Alkalosis. Partially
Compensated

b. Metabolic Alkalosis. Fully Compensated
c. Respiratory Acidosis. Partially
Compensated
d. Respiratory Alkalosis. Fully Compensated
39. PH 7.5. PaCO2 19. HCO3- 22
a. Respiratory Alkalosis. Partially
Compensated

b. Metabolic Alkalosis. Partially
Compensated
c. Respiratory Acidosis. Uncompensated
d. Respiratory Alkalosis. Uncompensated
40. PH 7.4. PaCO2 59. HCO3- 35
a. Respiratory Acidosis. Uncompensated
b. Metabolic Alkalosis. Uncompensated

c. Respiratory Acidosis. Fully Compensated
d. Metabolic Alkalosis. Partially
Compensated
41. Dave, a 6-year-old boy, was rushed to the
hospital following her mother’s complaint
that her son has been vomiting, nauseated

and has overall weakness. After series of
tests, the nurse notes the laboratory results:
potassium: 2.9 mEq. Which primary acid-base
imbalance is this boy at risk for if medical
intervention is not carried out?
a. Respiratory Acidosis
b. Respiratory Alkalosis
c. Metabolic Acidosis
d. Metabolic Alkalosis
42. An old beggar was admitted to the emergency
department due to shortness of breath, fever, and
a productive cough. Upon examination, crackles

and wheezes are noted in the lower lobes; he
appears to be tachycardic and has a bounding
pulse. Measurement of arterial blood gas shows
pH 7.2, PaCO2 66 mm Hg, HCO3 27 mmol/L, and
PaO2 65 mm Hg. As a knowledgeable nurse, you
know that the normal value for pH is:
a. 7.20
b. 7.30
c. 7.40
d. 7.50
43. Liza's mother is seen in the emergency
department at a community hospital. She admits
that her mother is taking many tablets of aspirin
(salicylates) over the last 24-hour period because

of a severe headache. Also, the mother complains
of an inability to urinate. The nurse on duty took
her vital signs and noted the following: Temp =
97.8 °F; apical pulse = 95; respiration = 32 and
deep. Which primary acid-base imbalance is the
client at risk for if medical attention is not
provided?
a. Respiratory Acidosis
b. Respiratory Alkalosis
c. Metabolic Acidosis
d. Metabolic Alkalosis
44. A patient who is hospitalized due to vomiting
and a decreased level of consciousness displays
slow and deep (Kussmaul breathing), and he is
lethargic and irritable in response to stimulation.

The doctor diagnosed him of having
dehydration. Measurement of arterial blood gas
shows pH 7.0, PaO2 90 mm Hg, PaCO2 22 mm
Hg, and HCO3 14 mmol/L; other results are Na+
120 mmol/L, K+ 2.5 mmol/L, and Cl- 95 mmol/L.
As a knowledgeable nurse, you know that the
normal value for PaCO2 is:
a. 22 mm Hg
b. 36 mm Hg
c. 48 mm Hg
d. 50 mm Hg
45. A company driver is found at the scene of
an automobile accident in a state of emotional
distress. He tells the paramedics that he feels

dizzy, tingling in his fingertips, and does not
remember what happened to his car.
Respiratory rate is rapid at 34/minute. Which
primary acid-base disturbance is the young
man at risk for if medical attention is not
provided?
a. Respiratory Acidosis
b. Respiratory Alkalosis
c. Metabolic Acidosis
d. Metabolic Alkalosis
46. An old man was admitted to hospital in a
coma. Analysis of the arterial blood gave the
following values: PCO2 16 mm Hg, HCO3- 5

mmol/L and pH 7.1. As a well-rounded nurse,
you know that the normal value for HCO3 is:
a. 20 mmol/L
b. 24 mmol/L
c. 29 mmol/L
d. 31 mmol/L
47. In a patient undergoing surgery, it was
vital to aspirate the contents of the upper
gastrointestinal tract. After the operation, the

following values were acquired from an
arterial blood sample: pH 7.55, PCO2 52 mm
Hg and HCO3- 40 mmol/l. What is the
underlying disorder?
a. Respiratory Acidosis
b. Respiratory Alkalosis
c. Metabolic Acidosis
d. Metabolic Alkalosis
48. A mountaineer attempts an assault on a
high mountain in the Andes and reaches an
altitude of 5000 meters (16,400 ft) above sea

level. What will happen to his arterial PCO2
and pH?
a. Both will be lower than normal.
b. The pH will rise and PCO2 will fall.
c. Both will be higher than normal due to the
physical exertion.
d. The pH will fall and PCO2 will rise
49. A young woman is found comatose,
having taken an unknown number of
sleeping pills an unknown time before. An

arterial blood sample yields the following
values: pH 6.90, HCO3- 13 meq/liter and
PaCO2 68 mmHg. This patient’s acid-base
status is most accurately described as:
a. Metabolic Acidosis
b. Respiratory Acidosis
c. Simultaneous Respiratory and Metabolic
Acidosis
d. Respiratory Acidosis with Complete Renal
Compensation
50. A mother is admitted in the emergency
department following complaints of fever and
chills. The nurse on duty took her vital signs

and noted the following: Temp = 100 °F;
apical pulse = 95; respiration = 20 and deep.
Measurement of arterial blood gas shows pH
7.37, PaO2 90 mm Hg, PaCO2 40 mm Hg, and
HCO3 24 mmol/L. What is your assessment?
a. Hyperthermia
b. Hyperthermia and Respiratory Alkalosis
c. Hypothermia
d. Hypothermia and Respiratory Alkalosis
HEMATOLOGIC
AND
IMMUNOLOGIC
DISORDERS
1. The parent child with suspected leukemia asks
the nurse why a bone marrow biopsy must be
performed. The nurse’s best reply is

a. “To draw blood for typing and cross-matching
should your child needs transfusion.”
b. “To help identify HLA compatible bone
marrow transplant donor.”
c. “It is the only way to confirm the diagnosis of
leukemia.”
d. “To compare biopsy cells with cells in blood to
help identify the source of the of the
leukemia.”
2. The nurse teaches a patient being
discharged home on ferrous sulfate

to take the medications
a. With meals, with water
b.Before meals, with milk
c. After meals, with citrus juice
d.Between meals, with tea
3. To prevent hemorrhage, the nurse
includes which of the following
interventions in the care plan of a

patient with aplastic anemia?
a. Provide meticulous hygiene
b. Avoid invasive procedures
c. Avoid fatigue producing activities
d. Apply pressure to arterial punctures
for 5 minutes
4. The primary nursing intervention
in therapeutic management of shock
is: 
a. Administering cortisone .
b.Initiating ventilator
management.
c. Administering sodium
bicarbonate.
d.Initiating IV therapy.
5. The nurse is performing an
assessment on a client with possible
pernicious anemia. Which data would

support this diagnosis?
a. A weight loss of 10 pounds in two
weeks
b. Complaints of numbness and tingling
in the extremities
c. A red, beefy tounge
d. A hemoglobin level of 12.0gm/dL
6. The primary cause of anemia
in a client with chronic renal
failure is: 
a. Poor iron absorption
b.Destruction of red blood cells
c. Lack of intrinsic factor
d.Insufficient erythropoietin
7. The nurse devises a teaching plan for the
client with aplastic anemia. Which of the
following is the most important concept to

teach for health promotion and maintenance?
a. Eat animal protein and dark geen, leafy
vegetables every day.
b. Avoid exposure to others with acute
infections.
c. Practice yoga and meditation to decrease
stress and anxiety.
d. Get 8 hours of sleep at night and take
naps during the day.
8. The nurse evaluates the teaching for the
patient with iron deficiency anemia has been
effective when the patient states:

a. “I will need to take the iron supplements
the rest of my life.”
b. “I will increase my dietary intake of milk
and milk products.”
c. “I should increase my activity to increase
my aerobic capacity.”
d. “I should take the iron for several
months after my blood is normal.”
9. In teaching the patient with pernicious
anemia about the disease, the nurse
explains that it results FROM a lack of:

a. Folic acid
b. Intrinsic factor
c. Extrinsic factor
d. Cyanocobalamine (Vitamin B12)
10. Nursing interventions for the patient
with aplastic anemia are directed toward
the prevention of the complication of::

a. fatigue and dyspnea
b. cardiac arrhythmias and heart
failure
c. thromboemboli and gangrene.
d. hemorrhage and infection .
11. In teaching the patient with
pernicious anemia about the disease,
the nurse explains that it results TO
a deficiency:
a. Folic acid
b. Intrinsic factor
c. Extrinsic factor
d. Cyanocobalamine (Vitamin B12)
12. Nursing interventions for the
patient with aplastic anemia are
prevention of
directed toward the
the complication of
a. fatigue and dyspnea
b.hemorrhage and infection
c. thromboemboli and gangrene.
d.cardiac arrhythmias and heart
failure.
13. During the care of the patient with
thrombocytopenia, the nurse,
a. takes frequent temperatures
 to
assess for fever.
b. maintains the patient on strict bed
rest to prevent injury.
c. monitors the patient for headache,
vertigo or confusion.
d. removes oral crusting and scabs with
firm friction every 2 hours.
14. In analyzing the laboratory results of
a patient with classic hemophilia, the
nurse would expect to find

a. an absence of all clotting facto
b. a decreased platelet count
c. an increased erythrocyte
sedimentation rate
d. a prolonged partial thromboplastin
time
15. Treatment of hemophilia most often
includes periodic administration of
a. whole blood 
b. thromboplastin
c. factor concentrates
d. fresh frozen plasma.
16. The most important method for
identifying the presence of infection
 is:
in a neutropenic patient
a. frequent temperatures
b.routine blood and sputum
studies
c. assessing for redness and
swelling.
d.monitoring WBC count.
17. While receiving a unit of packed red blood
cells, the patient develops chills and a
temperature of 39oC. The nurse

a. stops the transfusion, notifies the
physician and the blood bank.
b. stops the transfusion and removes the IV
catheter.
c. adds an IV infusion of NSS to dilute the
blood products.
d. recognized this as a mild allergic
transfusion reaction and slows the
transfusion.
18. Schilling’s test is used to determine
pernicious anemia but it is already obsolete.
In replace of the said diagnostic test,

nowadays, hospitals used _____________, as
found to be more definitive in diagnosing
pernicious anemia.
a. Serum vitamin B12
b. Urine test for vitamin B12
c. Stool examination
d. Guaiac test
19. In monitoring the patient with
Disseminated Intravascular
Coagulation (DIC), what is the most
common complication that is likely
to occur?
a. Shock
b.Cardiac arrest
c. Renal failure
d.Liver failure
20. The physician diagnosed a client
with leukemia. What would the
laboratory report indicate?

a. Large numbers of immature blast
cells.
b. Large number of RBCs and plateleT
c. Large number of mature WBCs.
d. A radical change in plasma
neutrophils.
21. The leukemic patient’s platelet count
is assessed prior to bone marrow
aspiration because:

a. Platelets are lost during aspiration.
b. It indicates presence of infection.
c. Blood may be too thick to aspirate.
d. Hemorrhage is a risk.
22. The nurse is assessing a client
diagnosed with acute myeloid leukemia.
Which assessment data support this
diagnosis?

a. Fever and infections.
b. Nausea and vomiting.
c. Excessive energy and high platelet
counts.
d. Cervical lymph node enlargement
and positive acid-fast bacillus.
23. The client diagnosed with leukemia has
central nervous system involvement. Which
instructions should the nurse teach?

a. Sleep with the head of the bed elevated
to prevent increased intracranial
pressure.
b. Take an analgesic medication for pain
only when the pain becomes severe.
c. Explain that radiation therapy to the head
may result in permanent hair loss.
d. Discuss end-of-life decisions prior to
cognitive deterioration.
24. The client diagnosed with leukemia is
being admitted for an induction course of
chemotherapy. Which laboratory values

indicate a diagnosis of leukemia?
a. A left shift in the white blood cell count
differential.
b. A large number of WBCs that decreases
after the administration of antibiotics.
c. An abnormally low hemoglobin (Hgb)
and hematocrit (Hct) level.
d. Red blood cells that are larger than
normal.
25. Which medication is contraindicated
for a client diagnosed with leukemia?
a. Bactrim, a sulfa
antibiotic.
b. Morphine, a narcotic analgesic.
c. Epogen, a biologic response
modifier.
d. Gleevec, a genetic blocking agent.
26. The nurse and an unlicensed nursing
assistant are caring for clients in a bone
marrow transplant unit. Which nursing task

should the nurse delegate?
a. Take the hourly vital signs on a client
receiving blood transfusions.
b. Monitor the infusion of antineoplastic
medications.
c. Transcribe the doctor’s orders onto the
Medication Administration Record
(MAR).
d. Determine the client’s response to the
therapy.
27. Which client would be most at risk for
developing disseminated intravascular
coagulation (DIC)?

a. A 35-year-old pregnant client with
placenta previa.
b. A 42-year-old client with a pulmonary
embolus.
c. A 60-year-old client receiving
hemodialysis three (3) days a week.
d. A 78-year-old client diagnosed with
septicemia.
28. The client admitted with full-
thickness burns may be developing DIC.
Which signs/ symptoms would support

the diagnosis of DIC?
a. Oozing blood from the IV catheter
site.
b. Sudden onset of chest pain and
frothy sputum.
c. Foul smelling, concentrated urine.
d. A reddened, inflamed central line
catheter site.
29. Which laboratory result would the
nurse expect in the client diagnosed with
DIC?

a. A decreased prothrombin time (PT).
b. A low fibrinogen level.
c. An increased platelet count.
d. An increased white blood cell count.
30. Which collaborative treatment
would the nurse anticipate for
 with DIC?
the client diagnosed
a.Administer oral
anticoagulants.
b.Prepare for plasmapheresis.
c. Administer frozen plasma.
d.Calculate the intake and
output.
31. The unlicensed nursing assistant asks the
primary nurse, “How does someone get
hemophilia A?” Which statement would be

the primary nurse’s best response?
a. “It is an inherited x-linked recessive
disorder.”
b. “There is a deficiency of the clotting
factor VIII.”
c. “The person is born with hemophilia A.”
d. “The mother carries the gene and gives it
to the son.”
32. Which sign/symptom should the
nurse expect to assess in the client
diagnosed with hemophilia A?

a. Epistaxis. c. Subcutaneous
emphysema
b. Petechiae. d. Intermittent
claudication.
33. Which situation might cause the nurse to
think that the client has von Willebrand’s
disease?

a. The client has had unexplained episodes
of hematemesis.
b. The client has microscopic blood in the
urine.
c. The client has prolonged bleeding
following surgery.
d. The female client developed abruptio
placentae.
34. The client with hemophilia A is
experiencing hemarthrosis. Which
intervention should the nurse recommend to
the client? 
a. Alternate aspirin and acetaminophen to
help with the pain.
b. Apply cold packs for 24–48 hours to the
affected area.
c. Perform active range of motion exercise
on the extremity.
d. Put the affected extremity in the
dependent position.
35. Which sign would the nurse expect to
assess in the client diagnosed with
idiopathic thrombocytopenia purpura
(ITP)?

a. Petechiae on the anterior chest, arms,
and neck.
b. Capillary refill of less than three (3)
seconds.
c. An enlarged spleen.
d. Pulse oximeter reading of 95%.
36. The nurse is caring for the following
clients. Which client should the nurse assess
first?

a. The client whose partial thromboplastin
time (PTT) is 38 seconds.
b. The client’s whose hemoglobin is 14
gm/dL and hematocrit is 45%.
c. The client’s whose platelet count is
75,000 per milliliter of blood.
d. The client’s whose red blood cell count is
48 ----106 mm.
37. The client with O + blood is in need
of an emergency transfusion but the lab
does not have any O + blood available.

Which potential unit of blood could be
given to the client?
a. The O – unit c. The B + unit.
b. The A + unit d. Any Rh + unit.
38. The client is scheduled to have a total hip
replacement in two (2) months and has chosen
to prepare for autologous transfusions. Which

medication would the nurse administer to
prepare the client?
a. Prednisone, a glucocorticoid.
b. Zithromax, an antibiotic.
c. Ativan, a tranquilizer.
d. Epogen, a biologic response modifier.
39. Which statement is the scientific rationale
for infusing a unit of blood in less than four
(4) hours?

a. The blood will coagulate if left out of the
refrigerator for longer than four (4)
hours.
b. The blood has the potential for bacterial
growth if allowed to infuse longer.
c. The blood components begin to break
down after four (4) hours.
d. The blood will not be affected; this is a
laboratory procedure.
40. The client is diagnosed with severe iron-
deficiency anemia. Which statement is the
scientific rationale regarding oral replacement
therapy? 
a. Iron supplements are well tolerated
without side effects.
b. There is no benefit from oral
preparations; the best route is IV.
c. Oral iron preparations cause diarrhea if
not taken with food.
d. Very little of the iron supplement will be
absorbed by the body.
41. The client diagnosed with
anemia has an Hgb of 6.1 g/dL.
Which complication should the
nurse assess for?
a. Decreased pulmonary
functioning.
b.Impaired muscle functioning.
c. Congestive heart failure.
d.Altered gastric secretions.
42. The client diagnosed with cancer has
been undergoing systemic treatments
and has red blood cell deficiency. Which

signs and symptoms should the nurse
teach the client to manage?
a. Nausea associated with cancer
treatment.
b. Shortness of breath and fatigue.
c. Controlling mucositis and diarrhea.
d. The emotional aspects of having
cancer.
43. The nurse is assisting the doctor with
a bone marrow biopsy. Which
intervention postprocedure has priority?

a. Apply pressure to site for five (5) to
ten (10) minutes.
b. Medicate for pain with morphine
slow IVP.
c. Maintain head of bed in a high
Fowler’s position.
d. Apply oxygen via nasal cannula at 5
LPM.
44. A client is brought to the emergency room
stating that he has accidentally been taking two
times his prescribed dose of warfarin
(Coumadin) for the past week. After noting that

the client has no evidence of obvious bleeding,
the nurse plans to do which of the following
next?
a. Prepares to administer an antidote
b. Draws a sample for type and crossmatch and
transfuse the client
c. Draws a sample for an activated partial
thromboplastin time (aPTT) level
d. Draws a sample for prothrombin (PT) and
international normalized ratio (INR) level
45. A client is receiving a continuous infusion
of heparin sodium to treat deep vein
thrombosis. The client’s activated partial

thromboplastin (aPTT) time is 65 seconds.
The client’s baseline before the initiation of
therapy was 30 seconds. The nurse anticipates
that which action is needed?
a. Discontinue the heparin infusion
b. Increasing the rate of the heparin infusion
c. Decreasing the rate of the heparin infusion
d. Leaving the rate of the heparin infusion as
is.
46. A client had a 1000 ml bag of 5% dextrose in
0.9% sodium chloride hung at 3pm. The nurse
making rounds at 3;45pm finds that the client

is complaining of a pounding headache and is
dyspneic, experiencing chills, and
apprehensive with an increased pulse rate. The
intravenous bag has 400 ml remaining. The
nurse should take which of the following
actions first?
a. Call the physician c. Sit the client up in bed
b. Slow the IV infusion d. Remove the IV
catheter
47. The nurse has an order to hang an IV bag
of 1000 ml 5% dextrose in water with 20 mEq
potassium chloride. The nurse should plan to

do which of the following immediately after
injecting the potassium chloride into the port
of the intravenous bag?
a. Rotate the bag gently
b. Attach the tubing to the client
c. Prime the tubing with the IV solution
d. Check the solution for yellowish
discoloration
48. A client requiring surgery is anxious about
the possible need for a blood transfusion during
or after the procedure. The nurse advises the

client to do which of the following to reduce the
risk of possible transfusion reaction?
a. Give autologous blood donation before the
surgery
b. Ask a friend or family member to donate
blood ahead of time
c. Take iron supplements before surgery to
boost hemoglobin levels
d. Request that any donated blood be screened
twice by the blood bank
49. A client with major abdominal trauma
needs an emergency blood transfusion. The
client’s blood type is AB negative. Of the

blood types available, the safest type for the
nurse to administer is:
a. AB positive.
b. A positive.
c. B negative.
d. O positive.
50. A client with thrombocytopenia,
secondary to leukemia, develops epistaxis.
The nurse should instruct the client to:

a. lie supine with his neck extended.
b. sit upright, leaning slightly forward.
c. blow his nose and then put lateral pressure
on his nose.
d. hold his nose while bending forward at the
waist.
51. The nurse is preparing to administer iron
dextran (Imferon) to a client with iron
deficiency anemia. Which action is
appropriate? 
a. Using a 25G needle
b. Administering a Z-track injection
c. Using the same needle to draw up nthe
solution and to administer the injection
d. Preparing the deltoid site for injection
52. A nurse is reviewing the laboratory report
of a client who underwent a bone marrow
biopsy. The finding that would most strongly

support a diagnosis of acute leukemia is the
presence of a large number of immature:
a. monocytes.
b. thrombocytes.
c. basophils.
d. Leukocytes
53. A nurse is documenting her care for a
client with iron deficiency anemia.
Which nursing diagnosis is most
appropriate?

a. Impaired gas exchange
b. Deficient fluid volume
c. Ineffective airway clearance
d. Ineffective breathing pattern
54. A nurse is administering
cyanocobalamin (vitamin B12) to a client
with pernicious anemia, secondary to

gastrectomy. Which administration route
should the nurse use?
a. Topical route
b. Transdermal route
c. Enteral route
d. Parenteral route
55. Which among the following
organ/s is/are responsible for the

production of lymphocytes?
a. Bone marrow
b.Thymus
c. Tonsils
d.Both A and B
56. The bone marrow is responsible
for the production of the blood
components. Which among the
following are the specific cells
performing such function?
a. Branch cell
b.T-Cell
c. B-Cell
d.Stem cell
57. Immunization is the best
example of what type of immunity?
 immunity
a. Actively-acquired
b.Passively-acquired immunity
c. Artificially-acquired active
immunity
d.Naturally-acquired passive
immunity
58. What is the most abundant
immunoglobulin in our blood
plasma? 
a.IgJ
b.IgA
c. IgG
d.IgK
59. VZIg, HBIg, TIg, and Rig
available in the market offers what
type of immunity
1. Active 2. Passive
3. Naturally acquired 4. Artificially
acquired
a. 2 only
b. 1 and 4 only
c. 1, 2, 3, and 4
d. 2 and 4 only
60. HIV/AIDS suppresses what type
of immunity?
 immunity
a. B-cells’ Humoral
b.T-cells’ Humoral immunity
c. Cellular or Cell-mediatd
immunity
d.B-Cells’ Antibody-Antigen
immunity
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