Transcript MCQs for Nursing Students 15

MCQs for Nursing Students 15
Medical Surgical Nursing
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1. Randy has undergone kidney transplant, what assessment would prompt Nurse Katrina to
suspect organ rejection?
a. Sudden weight loss
b. Polyuria
c. Hypertension
d. Shock
1. Answer: (C) Hypertension
Hypertension, along with fever, and tenderness over the grafted kidney, reflects acute
rejection.
2. The immediate objective of nursing care for an overweight, mildly hypertensive male patient with
ureteral colic and hematuria is to decrease:
a. Pain
b. Weight
c. Hematuria
d. Hypertension
2. Answer: (A) Pain
Sharp, severe pain (renal colic) radiating toward the genitalia and thigh is caused by
urethral distention and smooth muscle spasm; relief from pain is the priority.
3. Matilda, with hyperthyroidism is to receive Lugol’s iodine solution before a subtotal
thyroidectomy is performed. The nurse is aware that this medication is given to:
a. Decrease the total basal metabolic rate.
b. Maintain the function of the parathyroid glands.
c. Block the formation of thyroxine by the thyroid gland.
d. Decrease the size and vascularity of the thyroid gland.
3. Answer: (D) Decrease the size and vascularity of the thyroid gland.
Lugol’s solution provides iodine, which aids in decreasing the vascularity of the thyroid
gland, which limits the risk of hemorrhage when surgery is performed.
4. Ricardo, was diagnosed with type I diabetes. The nurse is aware that acute hypoglycemia also
can develop in the patient who is diagnosed with:
a. Liver disease
a. Liver disease
b. Hypertension
c. Type 2 diabetes
d. Hyperthyroidism
4. Answer: (A) Liver Disease
The patient with liver disease has a decreased ability to metabolize carbohydrates
because of a decreased ability to form glycogen (glycogenesis) and to form glucose from
glycogen.
5. Tracy is receiving combination chemotherapy for treatment of metastatic carcinoma. Nurse
Ruby should monitor the patient for the systemic side effect of:
a. Ascites
b. Nystagmus
c. Leukopenia
d. Polycythemia
5. Answer: (C) Leukopenia
Leukopenia, a reduction in WBCs, is a systemic effect of chemotherapy as a result of
myelosuppression.
6. Norma, with recent colostomy expresses concern about the inability to control the passage of
gas. Nurse Oliver should suggest that the patient plan to:
a. Eliminate foods high in cellulose.
b. Decrease fluid intake at meal times.
c. Avoid foods that in the past caused flatus.
d. Adhere to a bland diet prior to social events.
6. Answer: (C) Avoid foods that in the past caused flatus.
Foods that bothered a person preoperatively will continue to do so after a colostomy.
7. Nurse Ron begins to teach a male patient how to perform colostomy irrigations. The nurse
would evaluate that the instructions were understood when the patient states, “I should:
a. Lie on my left side while instilling the irrigating solution.”
b. Keep the irrigating container less than 18 inches above the stoma.”
c. Instill a minimum of 1200 ml of irrigating solution to stimulate evacuation of the
bowel.”
d. Insert the irrigating catheter deeper into the stoma if cramping occurs during the
procedure.”
7. Answer: (B) Keep the irrigating container less than 18 inches above the stoma.”
This height permits the solution to flow slowly with little force so that excessive
peristalsis is not immediately precipitated.
8. Patrick is in the oliguric phase of acute tubular necrosis and is experiencing fluid and electrolyte
imbalances. The patient is somewhat confused and complains of nausea and muscle weakness. As part of
the prescribed therapy to correct this electrolyte imbalance, the nurse would expect to:
a. Administer Kayexalate
b. Restrict foods high in protein
c. Increase oral intake of cheese and milk.
d. Administer large amounts of normal saline via I.V.
8. Answer: (A) Administer Kayexalate
Kayexalate,a potassium exchange resin, permits sodium to be exchanged for potassium
in the intestine, reducing the serum potassium level.
9. Mario has burn injury. After 48 hours, the physician orders for Mario 2 liters of IV fluid to be
administered q12 h. The drop factor of the tubing is 10 gtt/ml. The nurse should set the flow to
provide:
a. 18 gtt/min
b. 28 gtt/min
c. 32 gtt/min
d. 36 gtt/min
9. Answer:(B) 28 gtt/min
This is the correct flow rate; multiply the amount to be infused (2000 ml) by the drop
factor (10) and divide the result by the amount of time in minutes (12 hours x 60
minutes)
10. Terence suffered from burn injury. Using the rule of nines, which has the largest percent
of burns?
a. Face and neck
b. Right upper arm and penis
c. Right thigh and penis
d. Upper trunk
10. Answer: (D) Upper trunk
The percentage designated for each burned part of the body using the rule of nines:
Head and neck 9%; Right upper extremity 9%; Left upper extremity 9%; Anterior trunk
18%; Posterior trunk 18%; Right lower extremity 18%; Left lower extremity 18%;
Perineum 1%.
11. Herbert, a 45 year old construction engineer is brought to the hospital unconscious after
falling from a 2-story building. When assessing the patient, the nurse would be most concerned if
the assessment revealed:
a. Reactive pupils
b. A depressed fontanel
c. Bleeding from ears
d. An elevated temperature
11. Answer: (C) Bleeding from ears
The nurse needs to perform a thorough assessment that could indicate alterations in
cerebral function, increased intracranial pressures, fractures and bleeding. Bleeding
from the ears occurs only with basal skull fractures that can easily contribute to
increased intracranial pressure and brain herniation.
12. Nurse Sherry is teaching male patient regarding his permanent artificial pacemaker. Which
information given by the nurse shows her knowledge deficit about the artificial cardiac
pacemaker?
a. take the pulse rate once a day, in the morning upon awakening
b. May be allowed to use electrical appliances
c. Have regular follow up care
d. May engage in contact sports
12. Answer: (D) may engage in contact sports
The patient should be advised by the nurse to avoid contact sports. This will prevent
trauma to the area of the pacemaker generator.
13. The nurse is ware that the most relevant knowledge about oxygen administration to a male
patient with COPD is
a. Oxygen at 1-2L/min is given to maintain the hypoxic stimulus for breathing.
b. Hypoxia stimulates the central chemoreceptors in the medulla that makes the
patient breath.
c. Oxygen is administered best using a non-rebreathing mask
d. Blood gases are monitored using a pulse oximeter.
13. Answer: (A) Oxygen at 1-2L/min is given to maintain the hypoxic stimulus for
breathing.
COPD causes a chronic CO2 retention that renders the medulla insensitive to the CO2
stimulation for breathing. The hypoxic state of the patient then becomes the stimulus for
breathing. Giving the patient oxygen in low concentrations will maintain the patient’s
hypoxic drive.
14. Tonny has undergoes a left thoracotomy and a partial pneumonectomy. Chest tubes are inserted, and
one-bottle water-seal drainage is instituted in the operating room. In the postanesthesia care unit Tonny is
placed in Fowler’s position on either his right side or on his back. The nurse is aware that this position:
a. Reduce incisional pain.
b. Facilitate ventilation of the left lung.
c. Equalize pressure in the pleural space.
d. Increase venous return
14. Answer: (B) Facilitate ventilation of the left lung.
Since only a partial pneumonectomy is done, there is a need to promote expansion of
this remaining Left lung by positioning the patient on the opposite unoperated side.
15. Kristine is scheduled for a bronchoscopy. When teaching Kristine what to expect afterward,
the nurse’s highest priority of information would be:
a. Food and fluids will be withheld for at least 2 hours.
b. Warm saline gargles will be done q 2h.
c. Coughing and deep-breathing exercises will be done q2h.
d. Only ice chips and cold liquids will be allowed initially.
15. Answer: (A) Food and fluids will be withheld for at least 2 hours.
Prior to bronchoscopy, the doctors sprays the back of the throat with anesthetic to
minimize the gag reflex and thus facilitate the insertion of the bronchoscope. Giving the
patient food and drink after the procedure without checking on the return of the gag
reflex can cause the patient to aspirate. The gag reflex usually returns after two hours.
16. Nurse Tristan is caring for a male patient in acute renal failure. The nurse should expect
hypertonic glucose, insulin infusions, and sodium bicarbonate to be used to treat:
a. hypernatremia.
b. hypokalemia.
c. hyperkalemia.
d. hypercalcemia.
16. Answer: (C) hyperkalemia.
Hyperkalemia is a common complication of acute renal failure. It’s life-threatening if
immediate action isn’t taken to reverse it. The administration of glucose and regular
insulin, with sodium bicarbonate if necessary, can temporarily prevent cardiac arrest by
moving potassium into the cells and temporarily reducing serum potassium
levels. Hypernatremia, hypokalemia, and hypercalcemia don’t usually occur with acute
renal failure and aren’t treated with glucose, insulin, or sodium bicarbonate.
17. Ms. X has just been diagnosed with condylomata acuminata (genital warts). What information
is appropriate to tell this patient?
a. This condition puts her at a higher risk for cervical cancer; therefore, she should
have a Papanicolaou (Pap) smear annually.
b. The most common treatment is metronidazole (Flagyl), which should eradicate the
problem within 7 to 10 days.
c. The potential for transmission to her sexual partner will be eliminated if condoms
are used every time they have sexual intercourse.
d. The human papillomavirus (HPV), which causes condylomata acuminata, can’t be
transmitted during oral sex.
17. Answer: (A) This condition puts her at a higher risk for cervical cancer; therefore, she
should have a Papanicolaou (Pap) smear annually.
Women with condylomata acuminata are at risk for cancer of the cervix and vulva.
Yearly Pap smears are very important for early detection. Because condylomata
acuminata is a virus, there is no permanent cure. Because condylomata acuminata can
occur on the vulva, a condom won’t protect sexual partners. HPV can be transmitted to
other parts of the body, such as the mouth, oropharynx, and larynx.
18. Maritess was recently diagnosed with a genitourinary problem and is being examined in the
emergency department. When palpating the her kidneys, the nurse should keep which
anatomical fact in mind?
a. The left kidney usually is slightly higher than the right one.
b. The kidneys are situated just above the adrenal glands.
c. The average kidney is approximately 5 cm (2″) long and 2 to 3 cm (¾” to 1-1/8″)
wide.
d. The kidneys lie between the 10th and 12th thoracic vertebrae.
18. Answer: (A) The left kidney usually is slightly higher than the right one.
The left kidney usually is slightly higher than the right one. An adrenal gland lies atop
each kidney. The average kidney measures approximately 11 cm (4-3/8″) long, 5 to 5.8
cm (2″ to 2¼”) wide, and 2.5 cm (1″) thick. The kidneys are located retroperitoneally, in
the posterior aspect of the abdomen, on either side of the vertebral column. They
lie between the 12th thoracic and 3rd lumbar vertebrae.
19. Jestoni with chronic renal failure (CRF) is admitted to the urology unit. The nurse is aware
that the diagnostic test are consistent with CRF if the result is:
a. Increased pH with decreased hydrogen ions.
b. Increased serum levels of potassium, magnesium, and calcium.
c. Blood urea nitrogen (BUN) 100 mg/dl and serum creatinine 6.5 mg/ dl.
d. Uric acid analysis 3.5 mg/dl and phenolsulfonphthalein (PSP) excretion 75%.
19. Answer: (C) Blood urea nitrogen (BUN) 100 mg/dl and serum creatinine 6.5 mg/dl.
The normal BUN level ranges 8 to 23 mg/dl; the normal serum creatinine level ranges
from 0.7 to 1.5 mg/dl. The test results in option C are abnormally elevated, reflecting
CRF and the kidneys’ decreased ability to remove nonprotein nitrogen waste from the
blood. CRF causes decreased pH and increased hydrogen ions — not vice versa. CRF
also increases serum levels of potassium, magnesium, and phosphorous, and decreases
serum levels of calcium. A uric acid analysis of 3.5 mg/dl falls within the normal range
of 2.7 to 7.7 mg/dl; PSP excretion of 75% also falls with the normal range of 60% to 75%.
20. Katrina has an abnormal result on a Papanicolaou test. After admitting that she read her chart
while the nurse was out of the room, Katrina asks what dysplasia means. Which definition
should the nurse provide?
a. Presence of completely undifferentiated tumor cells that don’t resemble cells of the
tissues of their origin.
b. Increase in the number of normal cells in a normal arrangement in a tissue or an
organ.
c. Replacement of one type of fully differentiated cell by another in tissues where the
second type normally isn’t found.
d. Alteration in the size, shape, and organization of differentiated cells.
20. Answer: (D) Alteration in the size, shape, and organization of differentiated cells
Dysplasia refers to an alteration in the size, shape, and organization of differentiated
cells. The presence of completely undifferentiated tumor cells that don’t resemble cells
of the tissues of their origin is called anaplasia. An increase in the number of normal
cells in a normal arrangement in a tissue or an organ is called hyperplasia. Replacement
of one type of fully differentiated cell by another in tissues where the second type
normally isn’t found is called metaplasia.
21. During a routine checkup, Nurse Marianne assesses a male patient with acquired
immunodeficiency syndrome (AIDS) for signs and symptoms ofcancer. What is the most common
AIDS-related cancer?
a. Squamous cell carcinoma
b. Multiple myeloma
c. Leukemia
d. Kaposi’s sarcoma
21. Answer: (D) Kaposi’s sarcoma
Kaposi’s sarcoma is the most common cancer associated with AIDS. Squamous cell
carcinoma, multiple myeloma, and leukemia may occur in anyone and aren’t associated
specifically with AIDS.
22. Ricardo is scheduled for a prostatectomy, and the anesthesiologist plans to use a spinal (subarachnoid)
block during surgery. In the operating room, the nurse positions the patient according to the
anesthesiologist’s instructions. Why does the patient require special positioning for this type of anesthesia?
a. To prevent confusion
b. To prevent seizures
c. To prevent cerebrospinal fluid (CSF) leakage
d. To prevent cardiac arrhythmias
22. Answer: (C) To prevent cerebrospinal fluid (CSF) leakage
The patient receiving a subarachnoid block requires special positioning to prevent CSF
leakage and headache and to ensure proper anesthetic distribution. Proper positioning
doesn’t help prevent confusion, seizures, or cardiac arrhythmias.
23. A male patient had a nephrectomy 2 days ago and is now complaining of abdominal pressure
and nausea. The first nursing action should be to:
a. Auscultate bowel sounds.
b. Palpate the abdomen.
c. Change the patient’s position.
d. Insert a rectal tube.
23. Answer: (A) Auscultate bowel sounds.
If abdominal distention is accompanied by nausea, the nurse must first auscultate bowel
sounds. If bowel sounds are absent, the nurse should suspect gastric or small intestine
dilation and these findings must be reported to the physician. Palpation should be
avoided postoperatively with abdominal distention. If peristalsis is absent, changing
positions and inserting a rectal tube won’t relieve the patient’s discomfort.
24. Wilfredo with a recent history of rectal bleeding is being prepared for a colonoscopy. How
should the nurse Patricia position the patient for this test initially?
a. Lying on the right side with legs straight
b. Lying on the left side with knees bent
c. Prone with the torso elevated
d. Bent over with hands touching the floor
24. Answer: (B) Lying on the left side with knees bent
For a colonoscopy, the nurse initially should position the patient on the left side with
knees bent. Placing the patient on the right side with legs straight, prone with the torso
elevated, or bent over with hands touching the floor wouldn’t allow proper
visualization of the large intestine.
25. A male patient with inflammatory bowel disease undergoes an ileostomy. On the first day
after surgery, Nurse Oliver notes that the patient’s stoma appears dusky. How should the nurse
interpret this finding?
a. Blood supply to the stoma has been interrupted.
b. This is a normal finding 1 day after surgery.
c. The ostomy bag should be adjusted.
d. An intestinal obstruction has occurred.
25. Answer: (A) Blood supply to the stoma has been interrupted
An ileostomy stoma forms as the ileum is brought through the abdominal wall to the
surface skin, creating an artificial opening for waste elimination. The stoma should
appear cherry red, indicating adequate arterial perfusion. A dusky stoma suggests
decreased perfusion, which may result from interruption of the stoma’s blood supply
and may lead to tissue damage or necrosis. A dusky stoma isn’t a normal finding.
Adjusting the ostomy bag wouldn’t affect stoma color, which depends on blood supply
to the area. An intestinal obstruction also wouldn’t change stoma color.
26. Anthony suffers burns on the legs, which nursing intervention helps prevent contractures?
a. Applying knee splints
b. Elevating the foot of the bed
c. Hyperextending the patient’s palms
d. Performing shoulder range-of-motion exercises
26. Answer: (A) Applying knee splints
Applying knee splints prevents leg contractures by holding the joints in a position of
function. Elevating the foot of the bed can’t prevent contractures because this action
doesn’t hold the joints in a position of function. Hyperextending a body part for an
extended time is inappropriate because it can cause contractures. Performing shoulder
range-of-motion exercises can prevent contractures in the shoulders, but not in the legs.
27. Nurse Ron is assessing a patient admitted with second- and third-degreeburns on the face,
arms, and chest. Which finding indicates a potential problem?
a. Partial pressure of arterial oxygen (PaO2) value of 80 mm Hg.
b. Urine output of 20 ml/hour.
c. White pulmonary secretions.
d. Rectal temperature of 100.6° F (38° C).
27. Answer: (B) Urine output of 20 ml/hour.
A urine output of less than 40 ml/hour in a patient with burns indicates a fluid volume
deficit. This patient’s PaO2 value falls within the normal range (80 to 100 mm Hg).
White pulmonary secretions also are normal. The patient’s rectal temperature isn’t
significantly elevated and probably results from the fluid volume deficit.
28. Mr. Mendoza who has suffered a cerebrovascular accident (CVA) is too weak to move on his
own. To help the patient avoid pressure ulcers, Nurse Celia should:
a. Turn him frequently.
b. Perform passive range-of-motion (ROM) exercises.
c. Reduce the patient’s fluid intake.
d. Encourage the patient to use a footboard.
28. Answer: (A) Turn him frequently.
The most important intervention to prevent pressure ulcers is frequent position changes,
which relieve pressure on the skin and underlying tissues. If pressure isn’t relieved,
capillaries become occluded, reducing circulation and oxygenation of the tissues and
resulting in cell death and ulcer formation. During passive ROM exercises, the nurse moves
each joint through its range of movement, which improves joint mobility and circulation to
the affected area but doesn’t prevent pressure ulcers. Adequate hydration is necessary to
maintain healthy skin and ensure tissue repair. A footboard prevents plantar flexion and
footdrop by maintaining the foot in a dorsiflexed position.
29. Nurse Maria plans to administer dexamethasone cream to a female patient who has dermatitis
over the anterior chest. How should the nurse apply this topical agent?
a. With a circular motion, to enhance absorption.
b. With an upward motion, to increase blood supply to the affected area
c. In long, even, outward, and downward strokes in the direction of hair growth
d. In long, even, outward, and upward strokes in the direction opposite hair growth
29. Answer: (C) In long, even, outward, and downward strokes in the direction of hair
growth
When applying a topical agent, the nurse should begin at the midline and use long,
even, outward, and downward strokes in the direction of hair growth. This application
pattern reduces the risk of follicle irritation and skin inflammation.
30. Nurse Kate is aware that one of the following classes of medication protect the ischemic
myocardium by blocking catecholamines and sympathetic nerve stimulation is:
a. Beta -adrenergic blockers
a. Beta -adrenergic blockers
b. Calcium channel blocker
c. Narcotics
d. Nitrates
30. Answer: (A) Beta -adrenergic blockers
Beta-adrenergic blockers work by blocking beta receptors in the myocardium, reducing the
response to catecholamines and sympathetic nerve stimulation. They protect the
myocardium, helping to reduce the risk of another infraction by decreasing myocardial
oxygen demand. Calcium channel blockers reduce the workload of the heart by decreasing
the heart rate. Narcotics reduce myocardial oxygen demand, promote vasodilation, and
decrease anxiety. Nitrates reduce myocardial oxygen consumption but decreases left
ventricular end diastolic pressure (preload) and systemic vascular resistance (afterload).
31. A male patient has jugular distention. On what position should the nurse place the head of
the bed to obtain the most accurate reading of jugular vein distention?
a. High Fowler’s
b. Raised 10 degrees
c. Raised 30 degrees
d. Supine position
31. Answer: (C) Raised 30 degrees
Jugular venous pressure is measured with a centimeter ruler to obtain the vertical
distance between the sternal angle and the point of highest pulsation with the head of
the bed inclined between 15 to 30 degrees. Increased pressure can’t be seen when the
patient is supine or when the head of the bed is raised 10 degrees because the point
that marks the pressure level is above the jaw (therefore, not visible). In high Fowler’s
position, the veins would be barely discernible above the clavicle.
32. The nurse is aware that one of the following classes of medications maximizes cardiac
performance in patients with heart failure by increasing ventricular contractility?
a. Beta-adrenergic blockers
b. Calcium channel blocker
c. Diuretics
d. Inotropic agents
32. Answer: (D) Inotropic agents
Inotropic agents are administered to increase the force of the heart’s contractions,
thereby increasing ventricular contractility and ultimately increasing cardiac output.
Beta-adrenergic blockers and calcium channel blockers decrease the heart rate and
ultimately decreased the workload of the heart. Diuretics are administered to decrease
the overall vascular volume, also decreasing the workload of the heart.
33. A male patient has a reduced serum high-density lipoprotein (HDL) level and an elevated
low-density lipoprotein (LDL) level. Which of the following dietary modifications is not
appropriate for this patient?
a. Fiber intake of 25 to 30 g daily
b. Less than 30% of calories from fat
c. Cholesterol intake of less than 300 mg daily
d. Less than 10% of calories from saturated fat
33. Answer: (B) Less than 30% of calories from fat
A patient with low serum HDL and high serum LDL levels should get less than 30% of
daily calories from fat. The other modifications are appropriate for this patient.
34. A 37-year-old male patient was admitted to the coronary care unit (CCU) 2 days ago with an
acute myocardial infarction. Which of the following actions would breach the patient
confidentiality?
a. The CCU nurse gives a verbal report to the nurse on the telemetry unit before
transferring the patient to that unit
b. The CCU nurse notifies the on-call physician about a change in the patient’s
condition
c. The emergency department nurse calls up the latest electrocardiogram results to
check the patient’s progress.
d. At the patient’s request, the CCU nurse updates the patient’s wife on his condition
34. Answer: (C) The emergency department nurse calls up the latest electrocardiogram
results to check the patient’s progress
The emergency department nurse is no longer directly involved with the patient’s care
and thus has no legal right to information about his present condition. Anyone directly
involved in his care (such as the telemetry nurse and the on-call physician) has the right
to information about his condition. Because the patient requested that the nurse
update his wife on his condition, doing so doesn’t breach confidentiality.
35. A male patient arriving in the emergency department is receiving cardiopulmonary resuscitation from
paramedics who are giving ventilations through an endotracheal (ET) tube that they placed in the patient’s
home. During a pause in compressions, the cardiac monitor shows narrow QRS complexes and a heart rate
of beats/minute with a palpable pulse. Which of the following actions should the nurse take first?
a. Start an L.V. line and administer amiodarone (Cardarone), 300 mg L.V. over 10
minutes.
b. Check endotracheal tube placement.
c. Obtain an arterial blood gas (ABG) sample.
d. Administer atropine, 1 mg L.V.
35. Answer: (B) Check endotracheal tube placement.
ET tube placement should be confirmed as soon as the patient arrives in the emergency
department. Once the airways is secured, oxygenation and ventilation should be confirmed
using an end-tidal carbon dioxide monitor and pulse oximetry. Next, the nurse should make
sure L.V. access is established. If the patient experiences symptomatic bradycardia, atropine
is administered as ordered 0.5 to 1 mg every 3 to 5 minutes to a total of 3 mg. Then the nurse
should try to find the cause of the patient’s arrest by obtaining an ABG sample. Amiodarone
is indicated for ventricular tachycardia, ventricular fibrillation and atrial flutter –
not symptomatic bradycardia.
36. After cardiac surgery, a patient’s blood pressure measures 126/80 mm Hg. Nurse Katrina
determines that mean arterial pressure (MAP) is which of the following?
a. 46 mm Hg
b. 80 mm Hg
c. 95 mm Hg
d. 90 mm Hg
36. Answer: (C) 95 mm Hg
Use the following formula to calculate MAP
MAP = systolic + 2 (diastolic)
3
MAP=126 mm Hg + 2 (80 mm Hg)
3
MAP=286 mm HG
3
MAP=95 mm Hg
37. A female patient arrives at the emergency department with chest and stomach pain and a
report of black tarry stool for several months. Which of the following order should the nurse
Oliver anticipate?
a. Cardiac monitor, oxygen, creatine kinase and lactate dehydrogenase levels
b. Prothrombin time, partial thromboplastin time, fibrinogen and fibrin split product
values.
c. Electrocardiogram, complete blood count, testing for occult blood, comprehensive
serum metabolic panel.
d. Electroencephalogram, alkaline phosphatase and aspartate aminotransferase levels,
basic serum metabolic panel
37. Answer: (C) Electrocardiogram, complete blood count, testing for occult blood,
comprehensive serum metabolic panel.
An electrocardiogram evaluates the complaints of chest pain, laboratory tests
determines anemia, and the stool test for occult blood determines blood in the stool. Cardiac
monitoring, oxygen, and creatine kinase and lactate dehydrogenase levels are appropriate
for a cardiac primary problem. A basic metabolic panel and alkaline phosphatase
and aspartate aminotransferase levels assess liver function. Prothrombin time, partial
thromboplastin time, fibrinogen and fibrin split products are measured to verify bleeding
dyscrasias, An electroencephalogram evaluates brain electrical activity.
38. Macario had coronary artery bypass graft (CABG) surgery 3 days ago. Which of the following
conditions is suspected by the nurse when a decrease in platelet count from 230,000 ul to 5,000 ul
is noted?
a. Pancytopenia
b. Idiopathic thrombocytopenic purpura (ITP)
c. Disseminated intravascular coagulation (DIC)
d. Heparin-associated thrombosis and thrombocytopenia (HATT)
38. Answer: (D) Heparin-associated thrombosis and thrombocytopenia (HATT)
HATT may occur after CABG surgery due to heparin use during surgery. Although DIC
and ITP cause platelet aggregation and bleeding, neither is common in a patient after
revascularization surgery. Pancytopenia is a reduction in all blood cells.
39. Which of the following drugs would be ordered by the physician to improve the platelet
count in a male patient with idiopathic thrombocytopenic purpura (ITP)?
a. Acetylsalicylic acid (ASA)
b. Corticosteroids
c. Methotrezate
d. Vitamin K
39. Answer: (B) Corticosteroids
Corticosteroid therapy can decrease antibody production and phagocytosis of the
antibody-coated platelets, retaining more functioning platelets. Methotrexate can cause
thrombocytopenia. Vitamin K is used to treat an excessive anticoagulate state
from warfarin overload, and ASA decreases platelet aggregation.
40. A female patient is scheduled to receive a heart valve replacement with a porcine valve. Which
of the following types of transplant is this?
a. Allogeneic
b. Autologous
c. Syngeneic
d. Xenogeneic
40. Answer: (D) Xenogeneic
An xenogeneic transplant is between is between human and another species. A
syngeneic transplant is between identical twins, allogeneic transplant is between two
humans, and autologous is a transplant from the same individual.
41. Marco falls off his bicycle and injuries his ankle. Which of the following actions shows the
initial response to the injury in the extrinsic pathway?
a. Release of Calcium
b. Release of tissue thromboplastin
c. Conversion of factors XII to factor XIIa
d. Conversion of factor VIII to factor VIIIa
41. Answer: (B) Release of tissue thromboplastin
Tissue thromboplastin is released when damaged tissue comes in contact with clotting
factors. Calcium is released to assist the conversion of factors X to Xa. Conversion of
factors XII to XIIa and VIII to VIII a are part of the intrinsic pathway.
42. Instructions for a patient with systemic lupus erythematosus (SLE) would include information
about which of the following blood dyscrasias?
a. Dressler’s syndrome
b. Polycythemia
c. Essential thrombocytopenia
d. Von Willebrand’s disease
42. Answer: (C) Essential thrombocytopenia
Essential thrombocytopenia is linked to immunologic disorders, such as SLE and
human immunodeficiency vitus. The disorder known as von Willebrand’s disease is a
type of hemophilia and isn’t linked to SLE. Moderate to severe anemia is associated
with SLE, not polycythemia. Dressler’s syndrome is pericarditis that occurs after
a myocardial infarction and isn’t linked to SLE.
43. The nurse is aware that the following symptoms is most commonly an early indication of
stage 1 Hodgkin’s disease?
a. Pericarditis
b. Night sweat
c. Splenomegaly
d. Persistent hypothermia
43. Answer: (B) Night sweat
In stage 1, symptoms include a single enlarged lymph node (usually), unexplained
fever, night sweats, malaise, and generalized pruritus. Although splenomegaly may be
present in some patients, night sweats are generally more prevalent. Pericarditis isn’t
associated with Hodgkin’s disease, nor is hypothermia. Moreover, splenomegaly
and pericarditis aren’t symptoms. Persistent hypothermia is associated with Hodgkin’s
but isn’t an early sign of the disease.
44. Francis with leukemia has neutropenia. Which of the following functions must frequently
assessed?
a. Blood pressure
b. Bowel sounds
c. Heart sounds
d. Breath sounds
44. Answer: (D) Breath sounds
Pneumonia, both viral and fungal, is a common cause of death in patients with
neutropenia, so frequent assessment of respiratory rate and breath sounds is required.
Although assessing blood pressure, bowel sounds, and heart sounds is important, it
won’t help detect pneumonia.
45. The nurse knows that neurologic complications of multiple myeloma (MM) usually involve
which of the following body system?
a. Brain
b. Muscle spasm
c. Renal dysfunction
d. Myocardial irritability
45. Answer: (B) Muscle spasm
Back pain or paresthesia in the lower extremities may indicate impending spinal cord
compression from a spinal tumor. This should be recognized and treated promptly as
progression of the tumor may result in paraplegia. The other options, which reflect parts
of the nervous system, aren’t usually affected by MM.
46. Nurse Patricia is aware that the average length of time from human immunodeficiency virus
(HIV) infection to the development of acquired immunodeficiency syndrome (AIDS)?
a. Less than 5 years
b. 5 to 7 years
c. 10 years
d. More than 10 years
46. Answer: (C)10 years
Epidemiologic studies show the average time from initial contact with HIV to the
development of AIDS is 10 years.
47. An 18-year-old male patient admitted with heat stroke begins to show signs of disseminated
intravascular coagulation (DIC). Which of the following laboratory findings is most consistent
with DIC?
a. Low platelet count
b. Elevated fibrinogen levels
c. Low levels of fibrin degradation products
d. Reduced prothrombin time
47. Answer: (A) Low platelet count
In DIC, platelets and clotting factors are consumed, resulting in microthrombi and
excessive bleeding. As clots form, fibrinogen levels decrease and the prothrombin time
increases. Fibrin degradation products increase as fibrinolysis takes places.
48. Mario comes to the clinic complaining of fever, drenching night sweats, and unexplained
weight loss over the past 3 months. Physical examination reveals a single enlarged
supraclavicular lymph node. Which of the following is the most probable diagnosis?
a. Influenza
b. Sickle cell anemia
c. Leukemia
d. Hodgkin’s disease
48. Answer: (D) Hodgkin’s disease
Hodgkin’s disease typically causes fever night sweats, weight loss, and lymph node
enlargement. Influenza doesn’t last for months. patients with sickle cell anemia manifest
signs and symptoms of chronic anemia with pallor of the mucous membrane, fatigue,
and decreased tolerance for exercise; they don’t show fever, night sweats, weight loss
or lymph node enlargement. Leukemia doesn’t cause lymph node enlargement.
49. A male patient with a gunshot wound requires an emergency blood transfusion. His blood
type is AB negative. Which blood type would be the safest for him to receive?
a. AB Rh-positive
b. A Rh-positive
c. A Rh-negative
d. O Rh-positive
49. Answer: (C) A Rh-negative
Human blood can sometimes contain an inherited D antigen. Persons with the D
antigen have Rh-positive blood type; those lacking the antigen have Rh-negative blood.
It’s important that a person with Rh-negative blood receives Rh-negative blood. If Rhpositive blood is administered to an Rh-negative person, the recipient develops antiRh agglutinins, and subsequent transfusions with Rh-positive blood may cause serious
reactions with clumping and hemolysis of red blood cells.
Situation: Stacy is diagnosed with acute lymphoid leukemia (ALL) and beginning chemotherapy.
50. Stacy is discharged from the hospital following her chemotherapy treatments. Which
statement of Stacy’s mother indicated that she understands when she will contact the physician
a. “I should contact the physician if Stacy has difficulty in sleeping”.
b. “I will call my doctor if Stacy has persistent vomiting and diarrhea”.
c. “My physician should be called if Stacy is irritable and unhappy”.
d. “Should Stacy have continued hair loss, I need to call the doctor”.
50. Answer: (B) “I will call my doctor if Stacy has persistent vomiting and diarrhea”.
Persistent (more than 24 hours) vomiting, anorexia, and diarrhea are signs of toxicity
and the patient should stop the medication and notify the health care provider. The
other manifestations are expected side effects of chemotherapy.
51. Stacy’s mother states to the nurse that it is hard to see Stacy with no hair. The best response for
the nurse is:
a. “Stacy looks very nice wearing a hat”.
b. “You should not worry about her hair, just be glad that she is alive”.
c. “Yes it is upsetting. But try to cover up your feelings when you are with her or else
she may be upset”.
d. “This is only temporary; Stacy will re-grow new hair in 3-6 months, but may be
different in texture”.
51. Answer: (D) “This is only temporary; Stacy will re-grow new hair in 3-6 months, but
may be different in texture”.
This is the appropriate response. The nurse should help the mother how to cope with
her own feelings regarding the child’s disease so as not to affect the child negatively.
When the hair grows back, it is still of the same color and texture.
52. Stacy has beginning stomatitis. To promote oral hygiene and comfort, the nurse in-charge
should:
a. Provide frequent mouthwash with normal saline.
b. Apply viscous Lidocaine to oral ulcers as needed.
c. Use lemon glycerine swabs every 2 hours.
d. Rinse mouth with Hydrogen Peroxide.
52. Answer: (B) Apply viscous Lidocaine to oral ulcers as needed.
Stomatitis can cause pain and this can be relieved by applying topical anesthetics such
as lidocaine before mouth care. When the patient is already comfortable, the nurse can
proceed with providing the patient with oral rinses of saline solution mixed with equal
part of water or hydrogen peroxide mixed water in 1:3 concentrations to promote
oral hygiene. Every 2-4 hours.
53. During the administration of chemotherapy agents, Nurse Oliver observed that the IV site is
red and swollen, when the IV is touched Stacy shouts in pain. The first nursing action to take is:
a. Notify the physician
b. Flush the IV line with saline solution
c. Immediately discontinue the infusion
d. Apply an ice pack to the site, followed by warm compress.
53. Answer: (C) Immediately discontinue the infusion
Edema or swelling at the IV site is a sign that the needle has been dislodged and the IV
solution is leaking into the tissues causing the edema. The patient feels pain as the
nerves are irritated by pressure and the IV solution. The first action of the nurse would
be to discontinue the infusion right away to prevent further edema and other
complication
54. The term “blue bloater” refers to a male patient which of the following conditions?
a. Adult respiratory distress syndrome (ARDS)
b. Asthma
c. Chronic obstructive bronchitis
d. Emphysema
54. Answer: (C) Chronic obstructive bronchitis
patients with chronic obstructive bronchitis appear bloated; they have large barrel chest
and peripheral edema, cyanotic nail beds, and at times, circumoral cyanosis. patients
with ARDS are acutely short of breath and frequently need intubation for mechanical
ventilation and large amount of oxygen. patients with asthma don’t exhibit
characteristics of chronic disease, and patients with emphysema appear pink and
cachectic.
55. The term “pink puffer” refers to the female patient with which of the following conditions?
a. Adult respiratory distress syndrome (ARDS)
b. Asthma
c. Chronic obstructive bronchitis
d. Emphysema
55. Answer: (D) Emphysema
Because of the large amount of energy it takes to breathe, patients with emphysemaare
usually cachectic. They’re pink and usually breathe through pursed lips, hence the term
“puffer.” patients with ARDS are usually acutely short of breath. patients with asthma
don’t have any particular characteristics, and patients with chronic obstructive
bronchitis are bloated and cyanotic in appearance.
56. Jose is in danger of respiratory arrest following the administration of a narcotic analgesic. An
arterial blood gas value is obtained. Nurse Oliver would expect the paco2 to be which of the
following values?
a. 15 mm Hg
b. 30 mm Hg
c. 40 mm Hg
d. 80 mm Hg
56. Answer: D 80 mm Hg
A patient about to go into respiratory arrest will have inefficient ventilation and will be
retaining carbon dioxide. The value expected would be around 80 mm Hg. All other
values are lower than expected.
57. Timothy’s arterial blood gas (ABG) results are as follows; pH 7.16; Paco2 80 mm Hg; Pao2 46
mm Hg; HCO3- 24 mEq/L; Sao2 81%. This ABG result represents which of the following
conditions?
a. Metabolic acidosis
b. Metabolic alkalosis
c. Respiratory acidosis
d. Respiratory alkalosis
57. Answer: (C) Respiratory acidosis
Because Paco2 is high at 80 mm Hg and the metabolic measure, HCO3- is normal, the
patient has respiratory acidosis. The pH is less than 7.35, academic, which eliminates
metabolic and respiratory alkalosis as possibilities. If the HCO3- was below 22 mEq/L
the patient would have metabolic acidosis.
58. Norma has started a new drug for hypertension. Thirty minutes after she takes the drug, she
develops chest tightness and becomes short of breath and tachypneic. She has a decreased level
of consciousness. These signs indicate which of the following conditions?
a. Asthma attack
b. Pulmonary embolism
c. Respiratory failure
d. Rheumatoid arthritis
58. Answer: (C) Respiratory failure
The patient was reacting to the drug with respiratory signs of impending anaphylaxis,
which could lead to eventually respiratory failure. Although the signs are also related to
an asthma attack or a pulmonary embolism, consider the new drug first. Rheumatoid
arthritis doesn’t manifest these signs.
Situation: Mr. Gonzales was admitted to the hospital with ascites and jaundice. To rule out cirrhosis of the liver:
59. Which laboratory test indicates liver cirrhosis?
a. Decreased red blood cell count
b. Decreased serum acid phosphatase level
c. Elevated white blood cell count
d. Elevated serum aminotransferase
59. Answer: (D) Elevated serum aminotransferase
Hepatic cell death causes release of liver enzymes alanine aminotransferase (ALT),
aspartate aminotransferase (AST) and lactate dehydrogenase (LDH) into the circulation.
Liver cirrhosis is a chronic and irreversible disease of the liver characterized by
generalized inflammation and fibrosis of the liver tissues.
60. The biopsy of Mr. Gonzales confirms the diagnosis of cirrhosis. Mr. Gonzales is at increased
risk for excessive bleeding primarily because of:
a. Impaired clotting mechanism
b. Varix formation
c. Inadequate nutrition
d. Trauma of invasive procedure
60. Answer: (A) Impaired clotting mechanism
Cirrhosis of the liver results in decreased Vitamin K absorption and formation of
clotting factors resulting in impaired clotting mechanism.
61. Mr. Gonzales develops hepatic encephalopathy. Which clinical manifestation is most common
with this condition?
a. Increased urine output
b. Altered level of consciousness
c. Decreased tendon reflex
d. Hypotension
62. When Mr. Gonzales regained co
61. Answer: (B) Altered level of consciousness
Changes in behavior and level of consciousness are the first signs of hepatic
encephalopathy. Hepatic encephalopathy is caused by liver failure and develops when
the liver is unable to convert protein metabolic product ammonia to urea. This results in
accumulation of ammonia and other toxic in the blood that damages the cells.
62. When Mr. Gonzales regained consciousness, the physician orders 50 ml of Lactulose p.o. every
2 hours. Mr. Gonzales develops diarrhea. The nurse best action would be:
a. “I’ll see if your physician is in the hospital”.
b. “Maybe you’re reacting to the drug; I will withhold the next dose”.
c. “I’ll lower the dosage as ordered so the drug causes only 2 to 4 stools a day”.
d. “Frequently, bowel movements are needed to reduce sodium level”.
62. Answer: (C) “I’ll lower the dosage as ordered so the drug causes only 2 to 4 stools a
day”.
Lactulose is given to a patients with hepatic encephalopathy to reduce absorption of
ammonia in the intestines by binding with ammonia and promoting more frequent
bowel movements. If the patient experience diarrhea, it indicates over dosage and the
nurse must reduce the amount of medication given to the patient. The stool will be
mushy or soft. Lactulose is also very sweet and may cause cramping and bloating.
63. Which of the following groups of symptoms indicates a ruptured abdominal aortic aneurysm?
a. Lower back pain, increased blood pressure, decreased re blood cell (RBC) count,
increased white blood (WBC) count.
b. Severe lower back pain, decreased blood pressure, decreased RBC count, increased
WBC count.
c. Severe lower back pain, decreased blood pressure, decreased RBC count, decreased
RBC count, decreased WBC count.
d. Intermittent lower back pain, decreased blood pressure, decreased RBC count,
increased WBC count.
63. Answer: (B) Severe lower back pain, decreased blood pressure, decreased RBC count,
increased WBC count.
Severe lower back pain indicates an aneurysm rupture, secondary to pressure being applied
within the abdominal cavity. When ruptured occurs, the pain is constant because it can’t be
alleviated until the aneurysm is repaired. Blood pressure decreases due to the loss of blood.
After the aneurysm ruptures, the vasculature is interrupted and blood volume is lost, so
blood pressure wouldn’t increase. For the same reason, the RBC count is decreased – not
increased. The WBC count increases as cell migrate to the site of injury.
64. After undergoing a cardiac catheterization, Tracy has a large puddle of blood under his
buttocks. Which of the following steps should the nurse take first?
a. Call for help.
b. Obtain vital signs
c. Ask the patient to “lift up”
d. Apply gloves and assess the groin site
64. Answer: (D) Apply gloves and assess the groin site
Observing standard precautions is the first priority when dealing with any blood fluid.
Assessment of the groin site is the second priority. This establishes where the blood is
coming from and determines how much blood has been lost. The goal in this situation is
to stop the bleeding. The nurse would call for help if it were warranted after the
assessment of the situation. After determining the extent of the bleeding, vital signs
assessment is important. The nurse should never move the patient, in case a clot has
formed. Moving can disturb the clot and cause rebleeding.
65. Which of the following treatment is a suitable surgical intervention for a patient with
unstable angina?
a. Cardiac catheterization
b. Echocardiogram
c. Nitroglycerin
d. Percutaneous transluminal coronary angioplasty (PTCA)
65. Answer: (D) Percutaneous transluminal coronary angioplasty (PTCA)
PTCA can alleviate the blockage and restore blood flow and oxygenation. An
echocardiogram is a noninvasive diagnosis test. Nitroglycerin is an oral sublingual
medication. Cardiac catheterization is a diagnostic tool – not a treatment.
66. The nurse is aware that the following terms used to describe reduced cardiac output and
perfusion impairment due to ineffective pumping of the heart is:
a. Anaphylactic shock
b. Cardiogenic shock
c. Distributive shock
d. Myocardial infarction (MI)
66. Answer: (B) Cardiogenic shock
Cardiogenic shock is shock related to ineffective pumping of the heart. Anaphylactic
shock results from an allergic reaction. Distributive shock results from changes in the
intravascular volume distribution and is usually associated with increased cardiac
output. MI isn’t a shock state, though a severe MI can lead to shock.
67. A patient with hypertension ask the nurse which factors can cause blood pressure to drop to
normal levels?
a. Kidneys’ excretion to sodium only.
b. Kidneys’ retention of sodium and water
c. Kidneys’ excretion of sodium and water
d. Kidneys’ retention of sodium and excretion of water
67. Answer: (C) Kidneys’ excretion of sodium and water
The kidneys respond to rise in blood pressure by excreting sodium and excess water.
This response ultimately affects systolic blood pressure by regulating blood volume.
Sodium or water retention would only further increase blood pressure. Sodium and
water travel together across the membrane in the kidneys; one can’t travel without the
other.
68. Nurse Rose is aware that the statement that best explains why furosemide(Lasix) is
administered to treat hypertension is:
a. It dilates peripheral blood vessels.
b. It decreases sympathetic cardioacceleration.
c. It inhibits the angiotensin-converting enzymes
d. It inhibits reabsorption of sodium and water in the loop of Henle.
68. Answer: (D) It inhibits reabsorption of sodium and water in the loop of Henle.
Furosemide is a loop diuretic that inhibits sodium and water reabsorption in the loop
Henle, thereby causing a decrease in blood pressure. Vasodilators cause dilation of
peripheral blood vessels, directly relaxing vascular smooth muscle and decreasing
blood pressure. Adrenergic blockers decrease sympathetic cardioacceleration
and decrease blood pressure. Angiotensin-converting enzyme inhibitors decrease blood
pressure due to their action on angiotensin.
69. Nurse Nikki knows that laboratory results supports the diagnosis of systemic lupus
erythematosus (SLE) is:
a. Elevated serum complement level
b. Thrombocytosis, elevated sedimentation rate
c. Pancytopenia, elevated antinuclear antibody (ANA) titer
d. Leukocytosis, elevated blood urea nitrogen (BUN) and creatinine levels
69. Answer: (C) Pancytopenia, elevated antinuclear antibody (ANA) titer
Laboratory findings for patients with SLE usually show pancytopenia, elevated ANA
titer, and decreased serum complement levels. patients may have elevated BUN and
creatinine levels from nephritis, but the increase does not indicate SLE.
70. Arnold, a 19-year-old patient with a mild concussion is discharged from the emergency department.
Before discharge, he complains of a headache. When offered acetaminophen, his mother tells the nurse the
headache is severe and she would like her son to have something stronger. Which of the following
responses by the nurse is appropriate?
a. “Your son had a mild concussion, acetaminophen is strong enough.”
b. “Aspirin is avoided because of the danger of Reye’s syndrome in children or young
adults.”
c. “Narcotics are avoided after a head injury because they may hide a worsening
condition.”
d. Stronger medications may lead to vomiting, which increases the intracranial
pressure (ICP).”
70. Answer: (C) Narcotics are avoided after a head injury because they may hide a worsening
condition.
Narcotics may mask changes in the level of consciousness that indicate increased ICP and
shouldn’t acetaminophen is strong enough ignores the mother’s question and therefore isn’t
appropriate. Aspirin is contraindicated in conditions that may have bleeding, such as
trauma, and for children or young adults with viral illnesses due to the danger of
Reye’s syndrome. Stronger medications may not necessarily lead to vomiting but will sedate
the patient, thereby masking changes in his level of consciousness.
71. When evaluating an arterial blood gas from a male patient with a subdural hematoma, the
nurse notes the Paco2 is 30 mm Hg. Which of the following responses best describes the result?
a. Appropriate; lowering carbon dioxide (CO2) reduces intracranial pressure (ICP)
b. Emergent; the patient is poorly oxygenated
c. Normal
d. Significant; the patient has alveolar hypoventilation
71. Answer: (A) Appropriate; lowering carbon dioxide (CO2) reduces intracranial pressure (ICP)
A normal Paco2 value is 35 to 45 mm Hg CO2 has vasodilating properties; therefore, lowering Paco2
through hyperventilation will lower ICP caused by dilated cerebral vessels. Oxygenation is evaluated
through Pao2 and oxygen saturation. Alveolar hypoventilation would be reflected in an increased
Paco2. 71. Answer: (A) Appropriate; lowering carbon dioxide (CO2) reduces intracranial pressure
(ICP)
A normal Paco2 value is 35 to 45 mm Hg CO2 has vasodilating properties; therefore, lowering Paco2
through hyperventilation will lower ICP caused by dilated cerebral vessels. Oxygenation is evaluated
through Pao2 and oxygen saturation. Alveolar hypoventilation would be reflected in an increased
Paco2.
72. When prioritizing care, which of the following patients should the nurse Olivia assess first?
a. A 17-year-old patients 24-hours post appendectomy
b. A 33-year-old patient with a recent diagnosis of Guillain-Barre syndrome
c. A 50-year-old patient 3 days post myocardial infarction
d. A 50-year-old patient with diverticulitis
72. Answer: (B) A 33-year-old patient with a recent diagnosis of Guillain-Barre syndrome
Guillain-Barre syndrome is characterized by ascending paralysis and potential
respiratory failure. The order of patient assessment should follow patient priorities,
with disorder of airways, breathing, and then circulation. There’s no information to
suggest the postmyocardial infarction patient has an arrhythmia or other complication.
There’s no evidence to suggest hemorrhage or perforation for the remaining patients as
a priority of care.
73. JP has been diagnosed with gout and wants to know why colchicine is used in the treatment
of gout. Which of the following actions of colchicines explains why it’s effective for gout?
a. Replaces estrogen
b. Decreases infection
c. Decreases inflammation
d. Decreases bone demineralization
73. Answer: (C) Decreases inflammation
The action of colchicines is to decrease inflammation by reducing the migration of
leukocytes to synovial fluid. Colchicine doesn’t replace estrogen, decrease infection, or
decrease bone demineralization.
74. Norma asks for information about osteoarthritis. Which of the following statements
about osteoarthritis is correct?
a. Osteoarthritis is rarely debilitating
b. Osteoarthritis is a rare form of arthritis
c. Osteoarthritis is the most common form of arthritis
d. Osteoarthritis affects people over 60
74. Answer: (C) Osteoarthritis is the most common form of arthritis
Osteoarthritis is the most common form of arthritis and can be extremely debilitating. It
can afflict people of any age, although most are elderly.
75. Ruby is receiving thyroid replacement therapy develops the flu and forgets to take her thyroid
replacement medicine. The nurse understands that skipping this medication will put the patient
at risk for developing which of the following life threatening complications?
a. Exophthalmos
b. Thyroid storm
c. Myxedema coma
d. Tibial myxedema
75. Answer: (C) Myxedema coma
Myxedema coma, severe hypothyroidism, is a life-threatening condition that may
develop if thyroid replacement medication isn’t taken. Exophthalmos, protrusion of the
eyeballs, is seen with hyperthyroidism. Thyroid storm is life-threatening but is caused
by severe hyperthyroidism. Tibial myxedema, peripheral mucinous edema involving
the lower leg, is associated with hypothyroidism but isn’t life-threatening.
76. Nurse Sugar is assessing a patient with Cushing’s syndrome. Which observation should the
nurse report to the physician immediately?
a. Pitting edema of the legs
b. An irregular apical pulse
c. Dry mucous membranes
d. Frequent urination
76. Answer: (B) An irregular apical pulse
Because Cushing’s syndrome causes aldosterone overproduction, which increases
urinary potassium loss, the disorder may lead to hypokalemia. Therefore, the nurse
should immediately report signs and symptoms of hypokalemia, such as an irregular
apical pulse, to the physician. Edema is an expected finding because
aldosterone overproduction causes sodium and fluid retention. Dry mucous membranes
and frequent urination signal dehydration, which isn’t associated with Cushing’s
syndrome.
77. Cyrill with severe head trauma sustained in a car accident is admitted to the intensive care unit. Thirtysix hours later, the patient’s urine output suddenly rises above 200 ml/hour, leading the nurse to
suspect diabetesinsipidus. Which laboratory findings support the nurse’s suspicion ofdiabetes insipidus?
a. Above-normal urine and serum osmolality levels
b. Below-normal urine and serum osmolality levels
c. Above-normal urine osmolality level, below-normal serum osmolality level
d. Below-normal urine osmolality level, above-normal serum osmolality level
77. Answer: (D) Below-normal urine osmolality level, above-normal serum osmolality
level
In diabetes insipidus, excessive polyuria causes dilute urine, resulting in a belownormal urine osmolality level. At the same time, polyuria depletes the body of water,
causing dehydration that leads to an above-normal serum osmolality level. For the same
reasons, diabetes insipidus doesn’t cause above-normal urine osmolality or belownormal serum osmolality levels.
78. Jomari is diagnosed with hyperosmolar hyperglycemic nonketotic syndrome (HHNS) is stabilized and
prepared for discharge. When preparing the patient for discharge and home management, which of the
following statements indicates that the patient understands her condition and how to control it?
a. “I can avoid getting sick by not becoming dehydrated and by paying attention to
my need to urinate, drink, or eat more than usual.”
b. “If I experience trembling, weakness, and headache, I should drink a glass of soda
that contains sugar.”
c. “I will have to monitor my blood glucose level closely and notify the physician if it’s
constantly elevated.”
d. “If I begin to feel especially hungry and thirsty, I’ll eat a snack high in
carbohydrates.”
78. Answer: (A) “I can avoid getting sick by not becoming dehydrated and by paying
attention to my need to urinate, drink, or eat more than usual.”
Inadequate fluid intake during hyperglycemic episodes often leads to HHNS. By recognizing
the signs of hyperglycemia (polyuria, polydipsia, and polyphagia) and increasing fluid
intake, the patient may prevent HHNS. Drinking a glass of non diet soda would be
appropriate for hypoglycemia. A patient whose diabetes is controlled with oral
antidiabetic agents usually doesn’t need to monitor blood glucose levels. A high
carbohydrate diet would exacerbate the patient’s condition, particularly if fluid intake is low.
79. A 66-year-old patient has been complaining of sleeping more, increased urination, anorexia,
weakness, irritability, depression, and bone pain that interferes with her going outdoors. Based
on these assessment findings, the nurse would suspect which of the following disorders?
a. Diabetes mellitus
b. Diabetes insipidus
c. Hypoparathyroidism
d. Hyperparathyroidism
79. Answer: (D) Hyperparathyroidism
Hyperparathyroidism is most common in older women and is characterized by bone
pain and weakness from excess parathyroid hormone (PTH). patients also exhibit
hypercalciuria-causing polyuria. While patients with diabetes
mellitus and diabetesinsipidus also have polyuria, they don’t have bone pain and
increased sleeping. Hypoparathyroidism is characterized by urinary frequency rather
than polyuria.
80. Nurse Lourdes is teaching a patient recovering from addisonian crisis about the need to take
fludrocortisone acetate and hydrocortisone at home. Which statement by the patient indicates an
understanding of the instructions?
a. “I’ll take my hydrocortisone in the late afternoon, before dinner.”
b. “I’ll take all of my hydrocortisone in the morning, right after I wake up.”
c. “I’ll take two-thirds of the dose when I wake up and one-third in the late
afternoon.”
d. “I’ll take the entire dose at bedtime.”
80. Answer: (C) “I’ll take two-thirds of the dose when I wake up and one-third in the late
afternoon.”
Hydrocortisone, a glucocorticoid, should be administered according to a schedule that
closely reflects the body’s own secretion of this hormone; therefore, two-thirds of the
dose of hydrocortisone should be taken in the morning and one-third in the late
afternoon. This dosage schedule reduces adverse effects.
81. Which of the following laboratory test results would suggest to the nurse Len that a patient
has a corticotropin-secreting pituitary adenoma?
a. High corticotropin and low cortisol levels
b. Low corticotropin and high cortisol levels
c. High corticotropin and high cortisol levels
d. Low corticotropin and low cortisol levels
81. Answer: (C) High corticotropin and high cortisol levels
A corticotropin-secreting pituitary tumor would cause high corticotropin and high
cortisol levels. A high corticotropin level with a low cortisol level and a low
corticotropin level with a low cortisol level would be associated with hypocortisolism.
Low corticotropin and high cortisol levels would be seen if there was a primary defect
in the adrenal glands.
82. A male patient is scheduled for a transsphenoidal hypophysectomy to remove a pituitary
tumor. Preoperatively, the nurse should assess for potential complications by doing which of the
following?
a. Testing for ketones in the urine
b. Testing urine specific gravity
c. Checking temperature every 4 hours
d. Performing capillary glucose testing every 4 hours
82. Answer: (D) Performing capillary glucose testing every 4 hours
The nurse should perform capillary glucose testing every 4 hours because excess cortisol
may cause insulin resistance, placing the patient at risk for hyperglycemia. Urine ketone
testing isn’t indicated because the patient does secrete insulin and, therefore, isn’t at risk
for ketosis. Urine specific gravity isn’t indicated because although fluid balance can be
compromised, it usually isn’t dangerously imbalanced. Temperature regulation may be
affected by excess cortisol and isn’t an accurate indicator of infection.
83. Capillary glucose monitoring is being performed every 4 hours for a patient diagnosed with diabetic
ketoacidosis. Insulin is administered using a scale of regular insulin according to glucose results. At 2 p.m.,
the patient has a capillary glucose level of 250 mg/dl for which he receives 8 U of regular insulin. Nurse
Mariner should expect the dose’s:
a. onset to be at 2 p.m. and its peak to be at 3 p.m.
b. onset to be at 2:15 p.m. and its peak to be at 3 p.m.
c. onset to be at 2:30 p.m. and its peak to be at 4 p.m.
d. onset to be at 4 p.m. and its peak to be at 6 p.m.
83. Answer: (C) onset to be at 2:30 p.m. and its peak to be at 4 p.m.
Regular insulin, which is a short-acting insulin, has an onset of 15 to 30 minutes and a
peak of 2 to 4 hours. Because the nurse gave the insulin at 2 p.m., the expected onset
would be from 2:15 p.m. to 2:30 p.m. and the peak from 4 p.m. to 6 p.m.
84. The physician orders laboratory tests to confirm hyperthyroidism in a female patient with
classic signs and symptoms of this disorder. Which test result would confirm the diagnosis?
a. No increase in the thyroid-stimulating hormone (TSH) level after 30 minutes during
the TSH stimulation test
b. A decreased TSH level
c. An increase in the TSH level after 30 minutes during the TSH stimulation test
d. Below-normal levels of serum triiodothyronine (T3) and serum thyroxine (T4) as
detected by radioimmunoassay
84. Answer: (A) No increase in the thyroid-stimulating hormone (TSH) level after 30
minutes during the TSH stimulation test
In the TSH test, failure of the TSH level to rise after 30 minutes confirms
hyperthyroidism. A decreased TSH level indicates a pituitary deficiency of this
hormone. Below-normal levels of T3 and T4, as detected by radioimmunoassay, signal
hypothyroidism. A below-normal T4 level also occurs in malnutrition and liver disease
and may result from administration of phenytoin and certain other drugs.
85. Rico with diabetes mellitus must learn how to self-administer insulin. The physician has prescribed 10 U
of U-100 regular insulin and 35 U of U-100 isophane insulin suspension (NPH) to be taken before breakfast.
When teaching the patient how to select and rotate insulin injection sites, the nurse should provide which
instruction?
a. “Inject insulin into healthy tissue with large blood vessels and nerves.”
b. “Rotate injection sites within the same anatomic region, not among different
regions.”
c. “Administer insulin into areas of scar tissue or hypotrophy whenever possible.”
d. “Administer insulin into sites above muscles that you plan to exercise heavily later
that day.”
85. Answer: (B) “Rotate injection sites within the same anatomic region, not among different regions.”
The nurse should instruct the patient to rotate injection sites within the same anatomic region. Rotating
sites among different regions may cause excessive day-to-day variations in the blood glucose level; also,
insulin absorption differs from one region to the next. Insulin should be injected only into healthy tissue
lacking large blood vessels, nerves, or scar tissue or other deviations. Injecting insulin into areas of
hypertrophy may delay absorption. The patient shouldn’t inject insulin into areas of lipodystrophy
(such as hypertrophy or atrophy); to prevent lipodystrophy, the patient should rotate injection sites
systematically. Exercise speeds drug absorption, so the patient shouldn’t inject insulin into sites
above muscles that will be exercised heavily.
86. Nurse Sarah expects to note an elevated serum glucose level in a patient with hyperosmolar
hyperglycemic nonketotic syndrome (HHNS). Which other laboratory finding should the nurse
anticipate?
a. Elevated serum acetone level
b. Serum ketone bodies
c. Serum alkalosis
d. Below-normal serum potassium level
86. Answer: (D) Below-normal serum potassium level
A patient with HHNS has an overall body deficit of potassium resulting from diuresis,
which occurs secondary to the hyperosmolar, hyperglycemic state caused by the relative
insulin deficiency. An elevated serum acetone level and serum ketone bodies are
characteristic of diabetic ketoacidosis. Metabolic acidosis, not serum alkalosis, may
occur in HHNS.
87. For a patient with Graves’ disease, which nursing intervention promotes comfort?
a. Restricting intake of oral fluids
b. Placing extra blankets on the patient’s bed
c. Limiting intake of high-carbohydrate foods
d. Maintaining room temperature in the low-normal range
87. Answer: (D) Maintaining room temperature in the low-normal range
Graves’ disease causes signs and symptoms of hypermetabolism, such as heat
intolerance, diaphoresis, excessive thirst and appetite, and weight loss. To reduce heat
intolerance and diaphoresis, the nurse should keep the patient’s room temperature in
the low-normal range. To replace fluids lost via diaphoresis, the nurse
should encourage, not restrict, intake of oral fluids. Placing extra blankets on the bed of
a patient with heat intolerance would cause discomfort. To provide needed energy and
calories, the nurse should encourage the patient to eat high-carbohydrate foods.
88. Patrick is treated in the emergency department for a Colles’ fracture sustained during a fall.
What is a Colles’ fracture?
a. Fracture of the distal radius
b. Fracture of the olecranon
c. Fracture of the humerus
d. Fracture of the carpal scaphoid
88. Answer: (A) Fracture of the distal radius
Colles’ fracture is a fracture of the distal radius, such as from a fall on an outstretched
hand. It’s most common in women. Colles’ fracture doesn’t refer to a fracture of the
olecranon, humerus, or carpal scaphoid.
89. Cleo is diagnosed with osteoporosis. Which electrolytes are involved in the development of
this disorder?
a. Calcium and sodium
b. Calcium and phosphorous
c. Phosphorous and potassium
d. Potassium and sodium
89. Answer: (B) Calcium and phosphorous
In osteoporosis, bones lose calcium and phosphate salts, becoming porous, brittle, and
abnormally vulnerable to fracture. Sodium and potassium aren’t involved in the
development of osteoporosis.
90. Johnny a firefighter was involved in extinguishing a house fire and is being treated to smoke
inhalation. He develops severe hypoxia 48 hours after the incident, requiring intubation and
mechanical ventilation. He most likely has developed which of the following conditions?
a. Adult respiratory distress syndrome (ARDS)
b. Atelectasis
c. Bronchitis
d. Pneumonia
90. Answer: (A) Adult respiratory distress syndrome (ARDS)
Severe hypoxia after smoke inhalation is typically related to ARDS. The other conditions
listed aren’t typically associated with smoke inhalation and severe hypoxia.
91. A 67-year-old patient develops acute shortness of breath and progressive hypoxia following a
fracture of the right femur. The hypoxia was probably caused by which of the following
conditions?
a. Asthma attack
b. Atelectasis
c. Bronchitis
d. Fat embolism
91. Answer: (D) Fat embolism
Long bone fractures are correlated with fat emboli, which cause shortness of breath and
hypoxia. It’s unlikely the patient has developed asthma or bronchitis without a previous
history. He could develop atelectasis but it typically doesn’t produce progressive
hypoxia.er is
92. A patient with shortness of breath has decreased to absent breath sounds on the right side,
from the apex to the base. Which of the following conditions would best explain this?
a. Acute asthma
a. Acute asthma
b. Chronic bronchitis
c. Pneumonia
d. Spontaneous pneumothorax
92. Answer: (D) Spontaneous pneumothorax
A spontaneous pneumothorax occurs when the patient’s lung collapses, causing an
acute decreased in the amount of functional lung used in oxygenation. The sudden
collapse was the cause of his chest pain and shortness of breath. An asthma attack
would show wheezing breath sounds, and bronchitis would have
rhonchi.Pneumonia would have bronchial breath sounds over the area of consolidation.
93. A 62-year-old male patient was in a motor vehicle accident as an unrestrained driver. He’s now in the
emergency department complaining of difficulty of breathing and chest pain. On auscultation of his lung
field, no breath sounds are present in the upper lobe. This patient may have which of the following
conditions?
a. Bronchitis
b. Pneumonia
c. Pneumothorax
d. Tuberculosis (TB)
93. Answer: (C) Pneumothorax
From the trauma the patient experienced, it’s unlikely he has bronchitis, pneumonia, or
TB; rhonchi with bronchitis, bronchial breath sounds with TB would be heard.
94. If a patient requires a pneumonectomy, what fills the area of the thoracic cavity?
a. The space remains filled with air only
b. The surgeon fills the space with a gel
c. Serous fluids fills the space and consolidates the region
d. The tissue from the other lung grows over to the other side
94. Answer: (C) Serous fluids fills the space and consolidates the region
Serous fluid fills the space and eventually consolidates, preventing extensive
mediastinal shift of the heart and remaining lung. Air can’t be left in the space. There’s
no gel that can be placed in the pleural space. The tissue from the other lung can’t cross
the mediastinum, although a temporary mediastinal shift exits until the space is filled.
95. Hemoptysis may be present in the patient with a pulmonary embolism because of which of
the following reasons?
a. Alveolar damage in the infarcted area
b. Involvement of major blood vessels in the occluded area
c. Loss of lung parenchyma
d. Loss of lung tissue
95. Answer: (A) Alveolar damage in the infarcted area
The infarcted area produces alveolar damage that can lead to the production of bloody
sputum, sometimes in massive amounts. Clot formation usually occurs in the legs.
There’s a loss of lung parenchyma and subsequent scar tissue formation.
96. Alvin with a massive pulmonary embolism will have an arterial blood gas analysis performed
to determine the extent of hypoxia. The acid-base disorder that may be present is?
a. Metabolic acidosis
b. Metabolic alkalosis
c. Respiratory acidosis
d. Respiratory alkalosis
96. Answer: (D) Respiratory alkalosis
A patient with massive pulmonary embolism will have a large region and blow off large
amount of carbon dioxide, which crosses the unaffected alveolar-capillary membrane
more readily than does oxygen and results in respiratory alkalosis.
97. After a motor vehicle accident, Armand an 22-year-old patient is admitted with a pneumothorax. The
surgeon inserts a chest tube and attaches it to a chest drainage system. Bubbling soon appears in the water
seal chamber. Which of the following is the most likely cause of the bubbling?
a. Air leak
a. Air leak
b. Adequate suction
c. Inadequate suction
d. Kinked chest tube
97. Answer: (A) Air leak
Bubbling in the water seal chamber of a chest drainage system stems from an air leak. In
pneumothorax an air leak can occur as air is pulled from the pleural space. Bubbling
doesn’t normally occur with either adequate or inadequate suction or any preexisting
bubbling in the water seal chamber.
98. Nurse Michelle calculates the IV flow rate for a postoperative patient. The patient receives 3,000 ml of
Ringer’s lactate solution IV to run over 24 hours. The IV infusion set has a drop factor of 10 drops per
milliliter. The nurse should regulate the patient’s IV to deliver how many drops per minute?
a. 18
a. 18
b. 21
c. 35
d. 40
98. Answer: (B) 21
3000 x 10 divided by 24 x 60.
99. Mickey, a 6-year-old child with a congenital heart disorder is admitted with congestive heart
failure. Digoxin (lanoxin) 0.12 mg is ordered for the child. The bottle of Lanoxin contains .05 mg
of Lanoxin in 1 ml of solution. What amount should the nurse administer to the child?
a. 1.2 ml
b. 2.4 ml
c. 3.5 ml
d. 4.2 ml
99. Answer: (B) 2.4 ml
.05 mg/ 1 ml = .12mg/ x ml, .05x = .12, x = 2.4 ml.
100. Nurse Alexandra teaches a patient about elastic stockings. Which of the following
statements, if made by the patient, indicates to the nurse that the teaching was successful?
a. “I will wear the stockings until the physician tells me to remove them.”
b. “I should wear the stockings even when I am sleep.”
c. “Every four hours I should remove the stockings for a half hour.”
d. “I should put on the stockings before getting out of bed in the morning.”
100. Answer: (D) “I should put on the stockings before getting out of bed in the
morning.
Promote venous return by applying external pressure on veins.
10. Terence
The answer is