n Text Mode: All questions and answers are given for reading and answering at your own pace.

You can
also copy this exam and make a printout.

1. Which individual is at greatest risk for developing hypertension?

A. 45-year-old African American attorney

B. 60-year-old Asian American shop owner

C. 40-year-old Caucasian nurse

D. 55-year-old Hispanic teacher

2. A child who ingested 15 maximum strength acetaminophen tablets 45 minutes ago is seen in the
emergency department. Which of these orders should the nurse do first?

A. Gastric lavage PRN

B. Acetylcysteine (Mucomyst) for age per pharmacy

C. Start an IV Dextrose 5% with 0.33% normal saline to keep vein open

D. Activated charcoal per pharmacy

3. Which complication of cardiac catheterization should the nurse monitor for in the initial 24 hours
after the procedure?

A. angina at rest

B. thrombus formation

C. dizziness

D. falling blood pressure

4. A client is admitted to the emergency room with renal calculi and is complaining of moderate to
severe flank pain and nausea. The client’s temperature is 100.8 degrees Fahrenheit. The priority nursing
goal for this client is:

A. Maintain fluid and electrolyte balance

B. Control nausea

C. Manage pain

D. Prevent urinary tract infection

5. What would the nurse expect to see while assessing the growth of children during their school age
years?

A. Decreasing amounts of body fat and muscle mass

B. Little change in body appearance from year to year

C. Progressive height increase of 4 inches each year

D. Yearly weight gain of about 5.5 pounds per year

6. At a community health fair, the blood pressure of a 62-year-old client is 160/96 mmHg. The client
states “My blood pressure is usually much lower.” The nurse should tell the client to

A. go get a blood pressure check within the next 48 to 72 hours

B. check blood pressure again in two (2) months

C. see the healthcare provider immediately

D. visit the health care provider within one (1) week for a BP check

7. The hospital has sounded the call for a disaster drill on the evening shift. Which of these clients would
the nurse put first on the list to be discharged in order to make a room available for a new admission?
A. A middle-aged client with a history of being ventilator dependent for over seven (7) years and
admitted with bacterial pneumonia five days ago.

B. A young adult with diabetes mellitus Type 2 for over ten (10) years and admitted with antibiotic-
induced diarrhea 24 hours ago.

C. An elderly client with a history of hypertension, hypercholesterolemia, and lupus, and was admitted
with Stevens-Johnson syndrome that morning.

D. An adolescent with a positive HIV test and admitted for acute cellulitis of the lower leg 48 hours ago.

8. A client has been newly diagnosed with hypothyroidism and will take levothyroxine (Synthroid) 50
mcg/day by mouth. As part of the teaching plan, the nurse emphasizes that this medication:

A. Should be taken in the morning

B. May decrease the client’s energy level

C. Must be stored in a dark container

D. Will decrease the client’s heart rate

9. A 3-year-old child comes to the pediatric clinic after the sudden onset of findings that include
irritability, thick muffled voice, croaking on inspiration, hot to touch, sit leaning forward, tongue
protruding, drooling and suprasternal retractions. What should the nurse do first?

A. Prepare the child for X-ray of upper airways

B. Examine the child’s throat

C. Collect a sputum specimen

D. Notify the healthcare provider of the child’s status

10. In children suspected to have a diagnosis of diabetes, which one of the following complaints would
be most likely to prompt parents to take their school-age child for evaluation?
A. Polyphagia

B. Dehydration

C. Bedwetting

D. Weight loss

11. A client comes to the clinic for treatment of recurrent pelvic inflammatory disease. The nurse
recognizes that this condition most frequently follows which type of infection?

A. Trichomoniasis

B. Chlamydia

C. Staphylococcus

D. Streptococcus

12. An RN who usually works in a spinal rehabilitation unit is floated to the emergency department.
Which of these clients should the charge nurse assign to this RN?

A. A middle-aged client who says “I took too many diet pills” and “my heart feels like it is racing out of
my chest.”

B. A young adult who says “I hear songs from heaven. I need money for beer. I quit drinking two (2) days
ago for my family. Why are my arms and legs jerking?”

C. An adolescent who has been on pain medications terminal cancer with an initial assessment finding
pupils and a relaxed respiratory rate of 10,

D. An elderly client who reports having taken a “large crack hit” 10 minutes prior to walking into the
emergency room.

13. When teaching a client with coronary artery disease about nutrition, the nurse should emphasize
A. Eating three (3) balanced meals a day

B. Adding complex carbohydrates

C. Avoiding very heavy meals

D. Limiting sodium to 7 gms per day

14. Which of these findings indicate that a pump to deliver a basal rate of 10 ml per hour plus PRN for
pain breakthrough for morphine drip is not working?

A. The client complains of discomfort at the IV insertion site

B. The client states “I just can’t get relief from my pain.”

C. The level of drug is 100 ml at 8 AM and is 80 ml at noon

D. The level of the drug is 100 ml at 8 AM and is 50 ml at noon

15. The nurse is speaking at a community meeting about personal responsibility for health promotion. A
participant asks about chiropractic treatment for illnesses. What should be the focus of the nurse’s
response?

A. Electrical energy fields

B. Spinal column manipulation

C. Mind-body balance

D. Exercise of joints

16. The nurse is performing a neurological assessment on a client post right CVA. Which finding, if
observed by the nurse, would warrant immediate attention?

A. Decrease in level of consciousness

B. Loss of bladder control

C. Altered sensation to stimuli

D. Emotional ability

17. A child who has recently been diagnosed with cystic fibrosis is in a pediatric clinic where a nurse is
performing an assessment. Which later finding of this disease would the nurse not expect to see at this
time?

A. Positive sweat test

B. Bulky greasy stools

C. Moist, productive cough

D. Meconium ileus

18. The home health nurse visits a male client to provide wound care and finds the client lethargic and
confused. His wife states he fell down the stairs 2 hours ago. The nurse should

A. Place a call to the client’s health care provider for instructions

B. Send him to the emergency room for evaluation

C. Reassure the client’s wife that the symptoms are transient

D. Instruct the client’s wife to call the doctor if his symptoms become worse

19. Which of the following should the nurse implement to prepare a client for a KUB (Kidney, Ureter,
Bladder) radiograph test?

A. Client must be NPO before the examination

B. Enema to be administered prior to the examination

C. Medicate client with Lasix 20 mg IV 30 minutes prior to the examination

D. No special orders are necessary for this examination

20. The nurse is giving discharge teaching to a client trseven (7) days post myocardial infarction. He asks
the nurse why he must wait six (6) weeks before having sexual intercourse. What is the best response by
the nurse to this question?

A. “You need to regain your strength before attempting such exertion.”

B. “When you can climb 2 flights of stairs without problems, it is generally safe.”

C. “Have a glass of wine to relax you, then you can try to have sex.”

D. “If you can maintain an active walking program, you will have less risk.”

21. A triage nurse has these four (4) clients arrive in the emergency department within 15 minutes.
Which client should the triage nurse send back to be seen first?

A. A 2-month-old infant with a history of rolling off the bed and has bulging fontanels with crying

B. A teenager who got a singed beard while camping

C. An elderly client with complaints of frequent liquid brown colored stools

D. A middle-aged client with intermittent pain behind the right scapula

22. While planning care for a toddler, the nurse teaches the parents about the expected developmental
changes for this age. Which statement by the mother shows that she understands the child’s
developmental needs?

A. “I want to protect my child from any falls.”

B. “I will set limits on exploring the house.”

C. “I understand the need to use those new skills.”

D. “I intend to keep control over our child.”

23. The nurse is preparing to administer an enteral feeding to a client via a nasogastric feeding tube. The
most important action of the nurse is

A. Verify correct placement of the tube

B. Check that the feeding solution matches the dietary order

C. Aspirate abdominal contents to determine the amount of last feeding remaining in stomach

D. Ensure that feeding solution is at room temperature

24. The nurse is caring for a client with a serum potassium level of 3.5 mEq/L. The client is placed on a
cardiac monitor and receives 40 mEq KCL in 1000 ml of 5% dextrose in water IV. Which of the following
EKG patterns indicates to the nurse that the infusions should be discontinued?

A. Narrowed QRS complex

B. Shortened “PR” interval

C. Tall peaked “T” waves

D. Prominent “U” waves

25. A nurse prepares to care for a 4-year-old newly admitted for rhabdomyosarcoma. The nurse should
alert the staff to pay more attention to the function of which area of the body?

A. All striated muscles

B. The cerebellum

C. The kidneys

D. The leg bones

26. The nurse anticipates that for a family who practices Chinese medicine the priority goal would be to:
A. Achieve harmony

B. Maintain a balance of energy

C. Respect life

D. Restore yin and yang

27. During an assessment of a client with cardiomyopathy, the nurse finds that the systolic blood
pressure has decreased from 145 to 110 mm Hg and the heart rate has risen from 72 to 96 beats per
minute and the client complains of periodic dizzy spells. The nurse instructs the client to

A. Increase fluids that are high in protein

B. Restrict fluids

C. Force fluids and reassess blood pressure

D. Limit fluids to non-caffeine beverages

28. The nurse prepares the client for insertion of a pulmonary artery catheter (Swan-Ganz catheter). The
nurse teaches the client that the catheter will be inserted to provide information about:

A. Stroke volume

B. Cardiac output

C. Venous pressure

D. Left ventricular functioning

29. A nurse enters a client’s room to discover that the client has no pulse or respirations. After calling for
help, the first action the nurse should take is:

A. Start a peripheral IV

B. Initiate high-quality chest compressions

C. Establish an airway

D. Obtain the crash cart

30. A client is receiving digoxin (Lanoxin) 0.25 mg daily. The health care provider has written a new order
to give metoprolol (Lopressor) 25 mg B.I.D. In assessing the client prior to administering the
medications, which of the following should the nurse report immediately to the health care provider?

A. Blood pressure 94/60

B. Heart rate 76

C. Urine output 50 ml/hour

D. Respiratory rate 16

31. While assessing a 1-month-old infant, which finding should the nurse report immediately?

A. Abdominal respirations

B. Irregular breathing rate

C. Inspiratory grunt

D. Increased heart rate with crying

32. The nurse practicing in a maternity setting recognizes that the postmature fetus is at risk due to

A. Excessive fetal weight

B. Low blood sugar levels

C. Depletion of subcutaneous fat

D. Progressive placental insufficiency

33. The nurse is caring for a client who had a total hip replacement four (4) days ago. Which assessment
requires the nurse’s immediate attention?

A. I have bad muscle spasms in my lower leg of the affected extremity.

B. “I just can’t ‘catch my breath’ over the past few minutes and I think I am in grave danger.”

C. “I have to use the bedpan to pass my water at least every 1 to 2 hours.”

D. “It seems that the pain medication is not working as well today.”

34. A client has been taking furosemide (Lasix) for the past week. The nurse recognizes which finding
may indicate the client is experiencing a negative side effect from the medication?

A. Weight gain of 5 pounds

B. Edema of the ankles

C. Gastric irritability

D. Decreased appetite

35. A client who is pregnant comes to the clinic for a first visit. The nurse gathers data about her
obstetric history, which includes 3-year-old twins at home and a miscarriage 10 years ago at 12 weeks
gestation. How would the nurse accurately document this information?

A. Gravida 4 para 2

B. Gravida 2 para 1

C. Gravida 3 para 1

D. Gravida 3 para 2

36. The nurse is caring for a client with a venous stasis ulcer. Which nursing intervention would be most
effective in promoting healing?
A. Apply dressing using sterile technique

B. Improve the client’s nutrition status

C. Initiate limb compression therapy

D. Begin proteolytic debridement

37. A nurse is to administer meperidine hydrochloride (Demerol) 100 mg, atropine sulfate (Atropisol) 0.4
mg, and promethazine hydrochloride (Phenergan) 50 mg IM to a pre-operative client. Which action
should the nurse take first?

A. Raise the side rails on the bed

B. Place the call bell within reach

C. Instruct the client to remain in bed

D. Have the client empty bladder

38. Which of these statements best describes the characteristics of an effective reward-feedback
system?

A. Specific feedback is given as close to the event as possible

B. Staff is given feedback in equal amounts over time

C. Positive statements are to precede a negative statement

D. Performance goals should be higher than what is attainable

39. A client with multiple sclerosis plans to begin an exercise program. In addition to discussing the
benefits of regular exercise, the nurse should caution the client to avoid activities which

A. Increase the heart rate

B. Lead to dehydration

C. Are considered aerobic

D. May be competitive

40. During the evaluation of the quality of home care for a client with Alzheimer’s disease, the priority
for the nurse is to reinforce which statement by a family member?

A. At least two (2) full meals a day is eaten.

B. We go to a group discussion every week at our community center.

C. We have safety bars installed in the bathroom and have 24-hour alarms on the doors.

D. The medication is not a problem to have it taken three (3) times a day.

Answers and Rationale

1. Answer: A: 45-year-old African American attorney

The incidence of hypertension is greater among African Americans than other groups in the US. The
incidence among the Hispanic population is rising.

2. Answer: A: Gastric lavage PRN

Removing as much of the drug as possible is the first step in treatment for this drug overdose. This is
best done by gastric lavage. The next drug to give would be activated charcoal, then mucomyst and
lastly the IV fluids.

3. Answer: B: thrombus formation

Thrombus formation in the coronary arteries is a potential problem in the initial 24 hours after a cardiac
catheterization. A falling BP occurs along with hemorrhage of the insertion site which is associated with
the first 12 hours after the procedure.

4. Answer: C: Manage pain

The immediate goal of therapy is to alleviate the client’s pain.

5. Answer: D: Yearly weight gain of about 5.5 pounds per year

School age children gain about 5.5 pounds each year and increase about 2 inches in height.

6. Answer: A: go get a blood pressure check within the next 48 to 72 hours

The blood pressure reading is moderately high with the need to have it rechecked in a few days. The
client states it is ‘usually much lower.’ Thus a concern exists for complications such as stroke. However,
immediate check by the provider of care is not warranted. Waiting 2 months or a week for follow-up is
too long.

7. Answer: A: A middle-aged client with a history of being ventilator dependent for over 7 years and
admitted with bacterial pneumonia five days ago

The best candidate for discharge is one who has had a chronic condition and is most familiar with their
care. This client in option A is most likely stable and could continue medication therapy at home.

8. Answer: A: Should be taken in the morning

Thyroid supplement should be taken in the morning to minimize the side effects of insomnia
9. Answer: D: Notify the health care provider of the child’s status

These findings suggest a medical emergency and may be due to epiglottitis. Any child with an acute
onset of an inflammatory response in the mouth and throat should receive immediate attention in a
facility equipped to perform intubation or a tracheostomy in the event of further or complete
obstruction.

10. Answer: C: Bedwetting

In children, fatigue and bed wetting are the chief complaints that prompt parents to take their child for
evaluation. Bedwetting in a school-age child is readily detected by the parents.

11. Answer: B: Chlamydia

Chlamydial infections are one of the most frequent causes of salpingitis or pelvic inflammatory disease.

12. Answer: C: An adolescent who has been on pain medications for terminal cancer with an initial
assessment finding of pinpoint pupils and a relaxed respiratory rate of 10

Nurses who are floated to other units should be assigned to a client who has minimal anticipated
immediate complications of their problem. The client in option C exhibits opioid toxicity with the
pinpoint pupils and has the least risk of complications to occur in the near future.

13. Answer: C: Avoiding very heavy meals

Eating large, heavy meals can pull blood away from the heart for digestion and is dangerous for the
client with coronary artery disease.
14. Answer: C: The level of drug is 100 mL at 8 AM and is 80 mL at noon

The minimal dose of 10 mL per hour which would be 40 mL given in a four (4) hour period. Only 60 mL
should be left at noon. The pump is not functioning when more than expected medicine is left in the
container.

15. Answer: B: Spinal column manipulation

The theory underlying chiropractic is that interference with transmission of mental impulses between
the brain and body organs produces diseases. Such interference is caused by misalignment of the
vertebrae. Manipulation reduces the subluxation.

16. Answer: A: Decrease in level of consciousness

A further decrease in the level of consciousness would be indicative of a further progression of the CVA.

17. Answer: C: Moist, productive cough Option c is a later sign.

Noisy respirations and a dry non-productive cough are commonly the first of the respiratory signs to
appear in a newly diagnosed client with cystic fibrosis (CF). The other options are the earliest findings. CF
is an inherited (genetic) condition affecting the cells that produce mucus, sweat, saliva and digestive
juices. Normally, these secretions are thin and slippery, but in CF, a defective gene causes the secretions
to become thick and sticky. Instead of acting as a lubricant, the secretions plug up tubes, ducts, and
passageways, especially in the pancreas and lungs. Respiratory failure is the most dangerous
consequence of CF.

18. Answer: B: Send him to the emergency room for evaluation

This client requires immediate evaluation. A delay in treatment could result in further deterioration and
harm. Home care nurses must prioritize interventions based on assessment findings that are in the
client’s best interest.

19. Answer: D: No special orders are necessary for this examination

No special preparation is necessary for this examination.

20. Answer: B: “When you can climb 2 flights of stairs without problems, it is generally safe.”

There is a risk of cardiac rupture at the point of the myocardial infarction for about six (6) weeks. Scar
tissue should form about that time. Waiting until the client can tolerate climbing stairs is the usual
advice given by healthcare providers.

21. Answer: B: A teenager who got signed beard while camping

This client is in the greatest danger with a potential of respiratory distress. Any client with singed facial
hair has been exposed to heat or fire in close range that could have caused serious damage to the
interior of the lungs. Note that the interior lining of the lungs have no nerve fibers so the client will not
be aware of swelling.

22. Answer: C: “I understand the need to use those new skills.”

Erikson describes the stage of the toddler as being the time when there is normally an increase in
autonomy. The child needs to use motor skills to explore the environment.

23. Answer: A: Verify correct placement of the tube

Proper placement of the tube prevents aspiration.

24. Answer: C: Tall peaked T waves

A tall peaked T wave is a sign of hyperkalemia. The healthcare provider should be notified regarding
discontinuing the medication.

25. Answer: A: All striated muscles

Rhabdomyosarcoma is the most common children’s soft tissue sarcoma. It originates in striated
(skeletal) muscles and can be found anywhere in the body. The clue is in the middle of the word and is
“myo” which typically means muscle.

26. Answer: D: Restore yin and yang

For followers of Chinese medicine, health is maintained through the balance between the forces of yin
and yang.

27. Answer: C: Force fluids and reassess blood pressure

Postural hypotension, a decrease in systolic blood pressure of more than 15 mmHg and an increase in
heart rate of more than 15 percent usually accompanied by dizziness indicate volume depletion,
inadequate vasoconstrictor mechanisms, and autonomic insufficiency.

28. Answer: D. Left ventricular functioning

The catheter is placed in the pulmonary artery. Information regarding left ventricular function is
obtained when the catheter balloon is inflated.
29. Answer: B. Initiate high-quality chest compressions

As per new guidelines, the American Heart Association recommends beginning CPR with chest
compression (rather than checking for the airway first). Start CPR with 30 chest compressions before
checking the airway and giving rescue breaths. Starting with chest compressions first applies to adults,
children, and infants needing CPR, but not newborns. CPR can keep oxygenated blood flowing to the
brain and other vital organs until more definitive medical treatment can restore a normal heart rhythm.

30. Answer: A: Blood pressure 94/60

Both medications decrease the heart rate. Metoprolol affects blood pressure. Therefore, the heart rate
and blood pressure must be within normal range (HR 60-100; systolic BP over 100) in order to safely
administer both medications.

31. Answer: C: Inspiratory grunt

Inspiratory grunting is abnormal and may be a sign of respiratory distress in this infant.

32. Answer: D: Progressive placental insufficiency

The placenta functions less efficiently as the pregnancy continues beyond 42 weeks. Immediate and
long-term effects may be related to hypoxia.

33. Answer: B: “I just can’t ”catch my breath” over the past few minutes and I think I am in grave
danger.”

The nurse would be concerned about all of these comments. However, the most life-threatening is
option B. Clients who have had hip or knee surgery are at greatest risk for development of postoperative
pulmonary embolism. Sudden dyspnea and tachycardia are classic findings of pulmonary embolism.
Muscle spasms do not require immediate attention. Option C may indicate a urinary tract infection. And
option D requires further investigation and is not life-threatening.

34. Answer: D: Decreased appetite

Lasix causes a loss of potassium if a supplement is not taken. Signs and symptoms of hypokalemia
include anorexia, fatigue, nausea, decreased GI motility, muscle weakness, dysrhythmias.

35. Answer: C: Gravida 3 para 1

Gravida is the number of pregnancies and Parity is the number of pregnancies that reach viability (not
the number of fetuses). Thus, for this woman, she is now pregnant, had 2 prior pregnancies, and 1 viable
birth (twins).

36. Answer: B: Improve the client’s nutritional status

The goal of clinical management in a client with venous stasis ulcers is to promote healing. This only can
be accomplished with proper nutrition. The other answers are correct, but without proper nutrition, the
other interventions would be of little help.

37. Answer: D: Have the client empty bladder

The first step in the process is to have the client void prior to administering the pre-operative
medication. The other actions follow this initial step in this sequence: D, C, A and then B.

38. Answer: A: Specific feedback is given as close to the event as possible

Feedback is most useful when given immediately. Positive behavior is strengthened through immediate
feedback, and it is easier to modify problem behaviors if the standards are clearly understood.
39. Answer: B: Lead to dehydration

The client must take in adequate fluids before and during exercise periods.

40. Answer: C: We have safety bars installed in the bathroom and have 24-hour alarms on the doors.

Ensuring safety of the client with increasing memory loss is a priority of home care. Note all options are
correct statements. However, safety is most important to reinforce

In Text Mode: All questions and answers are given for reading and answering at your own pace. You can
also copy this exam and make a printout.

1. A nurse is reviewing a patient’s medication during shift change. Which of the following medications
would be contraindicated if the patient were pregnant? Select all that apply:

A. Warfarin (Coumadin)

B. Finasteride (Propecia, Proscar)

C. Celecoxib (Celebrex)
D. Clonidine (Catapres)

E. Transdermal nicotine (Habitrol)

F. Clofazimine(Lamprene)

2. A nurse is reviewing a patient’s past medical history (PMH). The history indicates the patient has
photosensitive reactions to medications. Which of the following drugs is associated with photosensitive
reactions? Select all that apply:

A. Ciprofloxacin (Cipro)

B. Sulfonamide

C. Norfloxacin (Noroxin)

D. Sulfamethoxazole and Trimethoprim (Bactrim)

E. Isotretinoin (Accutane)

F. Nitro-Dur patch

3. A patient tells you that her urine is starting to look discolored. If you believe this change is due to
medication, which of the following of the patient’s medication does not cause urine discoloration?

A. Sulfasalazine

B. Levodopa

C. Phenolphthalein

D. Aspirin

4. You are responsible for reviewing the nursing unit’s refrigerator. Which of the following drug, if found
inside the fridge, should be removed?

A. Nadolol (Corgard)
B. Opened (in-use) Humulin N injection

C. Urokinase (Kinlytic)

D. Epoetin alfa IV (Epogen)

5. A 34-year-old female has recently been diagnosed with an autoimmune disease. She has also recently
discovered that she is pregnant. Which of the following is the only immunoglobulin that will provide
protection to the fetus in the womb?

A. IgA

B. IgD

C. IgE

D. IgG

6. A second-year nursing student has just suffered a needlestick while working with a patient that is
positive for AIDS. Which of the following is the most significant action that nursing student should take?

A. Immediately see a social worker.

B. Start prophylactic AZT treatment.

C. Start prophylactic Pentamidine treatment.

D. Seek counseling.

7. A thirty-five-year-old male has been an insulin-dependent diabetic for five years and now is unable to
urinate. Which of the following would you most likely suspect?

A. Atherosclerosis

B. Diabetic nephropathy

C. Autonomic neuropathy
D. Somatic neuropathy

8. You are taking the history of a 14-year-old girl who has a (BMI) of 18. The girl reports inability to eat,
induced vomiting and severe constipation. Which of the following would you most likely suspect?

A. Multiple sclerosis

B. Anorexia nervosa

C. Bulimia nervosa

D. Systemic sclerosis

9. A 24-year-old female is admitted to the ER for confusion. This patient has a history of a myeloma
diagnosis, constipation, intense abdominal pain, and polyuria. Based on the presenting signs and
symptoms, which of the following would you most likely suspect?

A. Diverticulosis

B. Hypercalcemia

C. Hypocalcemia

D. Irritable bowel syndrome

10. Rhogam is most often used to treat____ mothers that have a ____ infant.

A. RH positive, RH positive

B. RH positive, RH negative

C. RH negative, RH positive

D. RH negative, RH negative
11. A new mother has some questions about phenylketonuria (PKU). Which of the following statements
made by a nurse is not correct regarding PKU?

A. A Guthrie test can check the necessary lab values.

B. The urine has a high concentration of phenylpyruvic acid

C. Mental deficits are often present with PKU.

D. The effects of PKU are reversible.

12. A patient has taken an overdose of aspirin. Which of the following should a nurse most closely
monitor for during acute management of this patient?

A. Onset of pulmonary edema

B. Metabolic alkalosis

C. Respiratory alkalosis

D. Parkinson’s disease type symptoms

13. A 50-year-old blind and deaf patient have been admitted to your floor. As the charge nurse, your
primary responsibility for this patient is?

A. Let others know about the patient’s deficits.

B. Communicate with your supervisor your patient safety concerns.

C. Continuously update the patient on the social environment.

D. Provide a secure environment for the patient.

14. A patient is getting discharged from a skilled nursing facility (SNF). The patient has a history of severe
COPD and PVD. The patient is primarily concerned about his ability to breathe easily. Which of the
following would be the best instruction for this patient?
A. Deep breathing techniques to increase oxygen levels.

B. Cough regularly and deeply to clear airway passages.

C. Cough following bronchodilator utilization.

D. Decrease CO2 levels by increased oxygen take output during meals.

15. A nurse is caring for an infant that has recently been diagnosed with a congenital heart defect.
Which of the following clinical signs would most likely be present?

A. Slow pulse rate

B. Weight gain

C. Decreased systolic pressure

D. Irregular WBC lab values

16. A mother has recently been informed that her child has Down’s syndrome. You will be assigned to
care for the child at shift change. Which of the following characteristics is not associated with Down’s
syndrome?

A. Simian crease

B. Brachycephaly

C. Oily skin

D. Hypotonicity

17. A client with myocardial infarction is receiving tissue plasminogen activator, alteplase (Activase, tPA).
While on the therapy, the nurse plans to prioritize which of the following?

A. Observe for neurological changes.

B. Monitor for any signs of renal failure.

C. Check the food diary.

D. Observe for signs of bleeding.

18. A patient asks a nurse, “My doctor recommended I increase my intake of folic acid. What type of
foods contain the highest concentration of folic acids?”

A. Green vegetables and liver

B. Yellow vegetables and red meat

C. Carrots

D. Milk

19. A nurse is putting together a presentation on meningitis. Which of the following microorganisms has
not been linked to meningitis in humans?

A. S. pneumoniae

B. H. influenzae

C. N. meningitidis

D. Cl. difficile

20. A nurse is administering blood to a patient who has a low hemoglobin count. The patient asks how
long to RBC’s last in my body? The correct response is.

A. The life span of RBC is 45 days.

B. The life span of RBC is 60 days.

C. The life span of RBC is 90 days.

D. The life span of RBC is 120 days.

21. A 65-year-old man has been admitted to the hospital for spinal stenosis surgery. When should the
discharge training and planning begin for this patient?

A. Following surgery

B. Upon admit

C. Within 48 hours of discharge

D. Preoperative discussion

22. A 5-year-old child and has been recently admitted to the hospital. According to Erik Erikson’s
psychosocial development stages, the child is in which stage?

A. Trust vs. mistrust

B. Initiative vs. guilt

C. Autonomy vs. shame and doubt

D. Intimacy vs. isolation

23. A toddler is 26 months old and has been recently admitted to the hospital. According to Erikson,
which of the following stages is the toddler in?

A. Trust vs. mistrust

B. Initiative vs. guilt

C. Autonomy vs. shame and doubt

D. Intimacy vs. isolation

24. A young adult is 20 years old and has been recently admitted to the hospital. According to Erikson,
which of the following stages is the adult in?
A. Trust vs. mistrust

B. Initiative vs. guilt

C. Autonomy vs. shame

D. Intimacy vs. isolation

25. A nurse is making rounds taking vital signs. Which of the following vital signs is abnormal?

A. 11-year-old male: 90 BPM, 22 RPM, 100/70 mmHg

B. 13-year-old female: 105 BPM, 22 RPM, 105/50 mmHg

C. 5-year-old male: 102 BPM, 24 RPM, 90/65 mmHg

D. 6-year-old female: 100 BPM, 26 RPM, 90/70 mmHg

26. When you are taking a patient’s history, she tells you she has been depressed and is dealing with an
anxiety disorder. Which of the following medications would the patient most likely be taking?

A. Amitriptyline (Elavil)

B. Calcitonin

C. Pergolide mesylate (Permax)

D. Verapamil (Calan)

27. Which of the following conditions would a nurse not administer erythromycin?

A. Campylobacteriosis infection

B. Legionnaire’s disease

C. Pneumonia
D. Multiple Sclerosis

28. A patient’s chart indicates a history of hyperkalemia. Which of the following would you not expect to
see with this patient if this condition were acute?

A. Decreased HR

B. Paresthesias

C. Muscle weakness of the extremities

D. Migraines

29. A patient’s chart indicates a history of ketoacidosis. Which of the following would you not expect to
see with this patient if this condition were acute?

A. Vomiting

B. Extreme Thirst

C. Weight gain

D. Acetone breath smell

30. A patient’s chart indicates a history of meningitis. Which of the following would you not expect to
see with this patient if this condition were acute?

A. Increased appetite

B. Vomiting

C. Fever

D. Poor tolerance of light

31. A nurse if reviewing a patient’s chart and notices that the patient suffers from conjunctivitis. Which
of the following microorganisms is related to this condition?

A. Yersinia pestis

B. Helicobacter pylori

C. Vibrio cholerae

D. Haemophilus aegyptius

32. A nurse if reviewing a patient’s chart and notices that the patient suffers from Lyme disease. Which
of the following microorganisms is related to this condition?

A. Borrelia burgdorferi

B. Streptococcus pyogenes

C. Bacillus anthracis

D. Enterococcus faecalis

33. A fragile 87-year-old female has recently been admitted to the hospital with increased confusion and
falls over last two (2) weeks. She is also noted to have a mild left hemiparesis. Which of the following
tests is most likely to be performed?

A. FBC (full blood count)

B. ECG (electrocardiogram)

C. Thyroid function tests

D. CT scan

34. An 84-year-old male has been losing mobility and gaining weight over the last two (2) months. The
patient also has the heater running in his house 24 hours a day, even on warm days. Which of the
following tests is most likely to be performed?
A. FBC (full blood count)

B. ECG (electrocardiogram)

C. Thyroid function tests

D. CT scan

35. A 20-year-old female attending college is found unconscious in her dorm room. She has a fever and a
noticeable rash. She has just been admitted to the hospital. Which of the following tests is most likely to
be performed first?

A. Blood sugar check

B. CT scan

C. Blood cultures

D. Arterial blood gases

36. A 28-year-old male has been found wandering around in a confused pattern. The male is sweaty and
pale. Which of the following tests is most likely to be performed first?

A. Blood sugar check

B. CT scan

C. Blood cultures

D. Arterial blood gases

37. A mother is inquiring about her child’s ability to potty train. Which of the following factors is the
most important aspect of toilet training?

A. The age of the child

B. The child’s ability to understand instruction.

C. The overall mental and physical abilities of the child.

D. Frequent attempts with positive reinforcement.

38. A parent calls the pediatric clinic and is frantic about the bottle of cleaning fluid her child drank 20
minutes. Which of the following is the most important instruction the nurse can give the parent?

A. This too shall pass.

B. Take the child immediately to the ER

C. Contact the Poison Control Center quickly

D. Give the child syrup of ipecac

39. A nurse is administering a shot of Vitamin K to a 30 day-old infant. Which of the following target
areas is the most appropriate?

A. Gluteus maximus

B. Gluteus minimus

C. Vastus lateralis

D. Vastus medialis

40. A nurse has just started her rounds delivering medication. A new patient on her rounds is a 4-year-
old boy who is non-verbal. This child does not have on any identification. What should the nurse do?

A. Contact the provider

B. Ask the child to write their name on paper.

C. Ask a coworker about the identification of the child.

D. Ask the father who is in the room the child’s name.

Answers and Rationale

1. Answers: A, and B.

Option A: Warfarin (Coumadin). Has a pregnancy category X and associated with central nervous system
defects, spontaneous abortion, stillbirth, prematurity, hemorrhage, and ocular defects when given
anytime during pregnancy and a fetal warfarin syndrome when given during the first trimester.

Option B: Finasteride (Propecia, Proscar). Also has a pregnancy category X which has a high risk of
causing permanent damage to the fetus.

Option C: Celecoxib (Celebrex). Large doses cause birth defects in rabbits; not known if the effect on
people is the same.

Option D: Clonidine (Catapres). Crosses the placenta but no adverse fetal effects have been observed.

Option E: Transdermal nicotine (Habitrol). Nicotine replacement products have been assigned to
pregnancy category C (nicotine gum) and category D (transdermal patches, inhalers, and spray nicotine
products).

Option F: Clofazimine (Lamprene). Clofazimine has been assigned to pregnancy category C.

2. Answers: A, B, C, D, and E.

Photosensitivity is an extreme sensitivity to ultraviolet (UV) rays from the sun and other light sources. A
type of photosensitivity called Phototoxic reactions are caused when medications in the body interact
with UV rays from the sun. Antiinfectives are the most common cause of this type of reaction.

3. Answer: D. Aspirin

Aspirin is not known to cause discoloration of the urine.

Option A: Sulfasalazine may discolor the urine or skin to an orange-yellow color.

Option B: Levodopa may discolor the urine, saliva, or sweat to a dark brown color.

Option C: Phenolphthalein can discolor the urine to a red color.

4. Answer: A. Corgard

Nadolol (Corgard) is stored at room temperature between 59 to 86 ºF (15 and 30 ºC) away from heat,
moisture, and light. Do not store in the bathroom and keep bottle tightly closed.

Option B: Humulin N injection if unopened (not in use) is stored in the fridge and is used until the
expiration date, or stored at room temperature and used within 31 days. If opened (in-use), store the
vial in a refrigerator or at room temperature and use within 31 days. Store the injection pen at room
temperature (do not refrigerate) and use within 14 days. Keep it in its original container protected from
heat and light. Do not draw insulin from a vial into a syringe until you are ready to give an injection. Do
not freeze insulin or store it near the cooling element in a refrigerator. Throw away any insulin that has
been frozen.

Option C: Urokinase (Kinlytic) is refrigerated at 2–8°C.

Option D: Epoetin alfa IV (Epogen) vials should be stored at 2°C to 8°C (36°F to 46°F); Do not freeze. Do
not shake. Protect from light.

5. Answer: D. IgG

IgG is the only immunoglobulin that can cross the placental barrier.

Option A: IgA antibodies protect body surfaces that are exposed to outside foreign substances.

Option B: IgD antibodies are found in small amounts in the tissues that line the belly or chest.

Option C: IgE antibodies cause the body to react against foreign substances such as pollen, spores,
animal dander.

6. Answer: B. Start prophylactic AZT treatment

Azidothymidine (AZT) treatment is the most critical intervention. It is an antiretroviral medication used
to prevent and treat HIV/AIDS by reducing the replication of the virus.

Options A and D: Other interventions mentioned are to be done later.

Option C: Pentamidine is an antimicrobial medication given to prevent and treat pneumocystis
pneumonia

7. Answer: C. Autonomic neuropathy

Autonomic neuropathy (also known as Diabetic Autonomic Neuropathy) affects the autonomic nerves,
which control the bladder, intestinal tract, and genitals, among other organs. Paralysis of the bladder is a
common symptom of this type of neuropathy.

Option A: Atherosclerosis, or hardening of the arteries, is a condition in which plaque builds up inside
the arteries. Plaque is made of cholesterol, fatty substances, cellular waste products, calcium and fibrin
(a clotting material in the blood).

Option B: Diabetic nephropathy (DN) is typically defined by macroalbuminuria—that is, a urinary

albumin excretion of more than 300 mg in a 24-hour collection—or macroalbuminuria and abnormal
renal function as represented by an abnormality in serum creatinine, calculated creatinine clearance, or
glomerular filtration rate (GFR). Clinically, diabetic nephropathy is characterized by a progressive
increase in proteinuria and decline in GFR, hypertension, and a high risk of cardiovascular morbidity and
mortality.

Option D: Somatic neuropathy affects the whole body and presents with diverse clinical pictures, most
common is the development of diabetic foot followed by diabetic ulceration and possible amputation.

8. Answer: B. Anorexia nervosa

All of the clinical signs and symptoms point to a condition of anorexia nervosa. The key feature of
anorexia nervosa is self-imposed starvation, resulting from a distorted body image and an intense,
irrational fear of gaining weight, even when the patient is emaciated. Anorexia nervosa may include
refusal to eat accompanied by compulsive exercising, self-induced vomiting, or laxative or diuretic
abuse.

Option A: Multiple sclerosis (MS) is a demyelinating disease in which the insulating covers of the nerve
cells in the brain and spinal cord are damaged.

Option C: On the other hand, bulimia nervosa features binge eating followed by a feeling of guilt,
humiliation, and self-deprecation. These feelings cause the patient to engage in self-induced vomiting,
use of laxatives or diuretics.

Option D: Systemic sclerosis or systemic scleroderma is an autoimmune disease of the connective tissue.
9. Answer: B. Hypercalcemia

Hypercalcemia can cause polyuria, severe abdominal pain, and confusion.

Option A: Diverticulosis is a condition that develops when pouches (diverticula) form in the wall of the
large intestine; most people don’t have symptoms.

Option C: Hypocalcemia is low calcium levels in the blood; it is asymptomatic in mild forms but can
cause paresthesia, tetany, muscle cramps, and carpopedal spasms in severe hypocalcemia.

Option D: Irritable bowel syndrome is a widespread condition involving recurrent abdominal pain and
diarrhea or constipation, often associated with stress, depression, anxiety, or previous intestinal
infection.

10. Answer: C. RH negative, RH positive

Rhogam prevents the production of anti-RH antibodies in the mother that has a Rh-positive fetus.

11. Answer: D. The effects of PKU are reversible.

Phenylketonuria (PKU) is an inherited disorder that increases the levels of phenylalanine (a building
block of proteins) in the blood. If PKU is not treated, phenylalanine can build up to harmful levels in the
body, causing intellectual disability and other serious health problems. The signs and symptoms of PKU
vary from mild to severe. The most severe form of this disorder is known as classic PKU. Infants with
classic PKU appear normal until they are a few months old. Without treatment, these children develop a
permanent intellectual disability. Seizures, delayed development, behavioral problems, and psychiatric
disorders are also common. Untreated individuals may have a musty or mouse-like odor as a side effect
of excess phenylalanine in the body. Children with classic PKU tend to have lighter skin and hair than
unaffected family members and are also likely to have skin disorders such as eczema. The effects of PKU
stay with the infant throughout their life (via Genetic Home Reference).

12. Answer: A. Onset of pulmonary edema

Aspirin overdose can lead to metabolic acidosis and cause pulmonary edema development.
Early symptoms of aspirin poisoning also include tinnitus, hyperventilation, vomiting, dehydration, and
fever. Late signs include drowsiness, bizarre behavior, unsteady walking, and coma. Abnormal breathing
caused by aspirin poisoning is usually rapid and deep.

Pulmonary edema may be related to an increase in permeability within the capillaries of the lung leading
to “protein leakage” and transudation of fluid in both renal and pulmonary tissues. The alteration in
renal tubule permeability may lead to a change in colloid osmotic pressure and thus facilitate pulmonary
edema (via Medscape).

13. Answer: D. Provide a secure environment for the patient.

This patient’s safety is your primary concern.

14. Answer: C. Cough following bronchodilator utilization

The bronchodilator will allow a more productive cough.

15. Answer: B. Weight gain

Weight gain due to fluid accumulation is associated with heart failure and congenital heart defects.

16. Answer: C. Oily skin

The skin would be dry and not oily.

17. Answer: D. Observe for signs of bleeding.

Bleeding is the priority concern for a client taking thrombolytic medication.

Options A and B: Are monitored but are not the primary concern.

Option C: is not related to the use of medication.

18. Answer: A. Green vegetables and liver

Green vegetables and liver are a great source of folic acid.

19. Answer: D. Cl. difficile

Cl. difficile has not been linked to meningitis.

20. Answer: D. The life span of RBC is 120 days.

Red blood cells have a lifespan of 120 in the body.

21. Answer: B. Upon admit

Discharge education begins upon admission.

22. Answer: B. Initiative vs. guilt

Initiative vs. guilt- 3-6 years old

23. Answer: C. Autonomy vs. shame

Autonomy vs Shame and doubt is at 12-18 months old

24. Answer: D. Intimacy vs. isolation

Intimacy vs. isolation- 18-35 years old

25. Answer: B. 13-year-old female: 105 BPM, 22 RPM, 105/50 mmHg

HR and Respirations are slightly increased. BP is down.

26. Answer: A. Elavil

Amitriptyline (Elavil) is a tricyclic antidepressant and used to treat symptoms of depression.

Option B: Calcitonin is used to treat osteoporosis in women who have been in menopause.

Option C: Pergolide mesylate (Permax) is used in the treatment of Parkinson’s disease.

Option D: Verapamil (Calan) is a calcium channel blocker.

27. Answer: D. Multiple Sclerosis

Erythromycin is used to treat conditions A-C.

28. Answer: D. Migraines

Answer choices A-C were symptoms of acute hyperkalemia.

29. Answer: C. Weight gain

Weight loss would be expected.

30. Answer: A. Increased appetite

Loss of appetite would be expected.

31. Answer: D. Haemophilus aegyptius

Option A: is linked to Plague

Option B: is linked to peptic ulcers

Option C: is linked to Cholera.

32. Answer: A. Borrelia burgdorferi

Option B: is linked to Rheumatic fever

Option C: is linked to Anthrax

Option D: is linked to Endocarditis.

33. Answer: D. CT scan

A CT scan would be performed for further investigation of the hemiparesis.

34. Answer: C. Thyroid function tests

Weight gain and poor temperature tolerance indicate something may be wrong with the thyroid
function.
35. Answer: C. Blood cultures

Blood cultures would be performed to investigate the fever and rash symptoms.

36. Answer: A. Blood sugar check

With a history of diabetes, the first response should be to check blood sugar levels.

37. Answer: C. The overall mental and physical abilities of the child.

Age is not the greatest factor in potty training. The overall mental and physical abilities of the child are
the most important factor.

38. Answer: C. Contact the Poison Control Center quickly

The poison control center will have an exact plan of action for this child.

39. Answer: C. Vastus lateralis

Vastus lateralis is the most appropriate location.

40. Answer: D. Ask the father who is in the room the child’s name.

In this case, you can determine the name of the child by the father’s statement. You should not withhold
the medication from the child after identification.
3