1. Which of the following laboratory results would suggest to the emergency room nurse that a client admitted after a severe motor vehicle crash is in acidosis?
B) Chloride 100 mEq/L
C) Sodium 130 mEq/L
D) Carbon dioxide 20 mEq/L
Serum carbon dioxide is an indicator of acid-base status. This finding would indicate acidosis.
B) Corticosteroids
C)Histamine blocker
D)Antibiotics
An anticholinergic medication will decrease gastric emptying and the pressure on the lower esophageal sphincter.
A) Notify the client's health care provider
B) Stop the infusion at 1:00 pm
C) Reschedule the laboratory test
D) Increase the infusion rate
If the antibiotic infusion will not be completed at the time the peak blood level is due to be drawn, the nurse should ask that the blood sampling time be adjusted
Key, J.L. and Hayes, E.R. (2003). Pharmacology, a nursing process approach. (4th edition).
B) An unfamiliar environment
C) Perceived loss of control
D) Guilt over being hospitalized
For school age children, major fears are loss of control and separation from friends/peers.
B)Appearance of jaundice
C) Tachycardia
D) Decreased hearing
The correct answer is B: Appearance of jaundice
Clients receiving INH therapy are at risk for developing drug induced hepatitis. The appearance of jaundice may indicate that the client has liver damage.
B)your appetite may increase for the first week.”
C)t is common to experience occasional sleep disturbances."
D) if you take the medication with food, you may have nausea."
Discoloration of the urine and other body fluids may occur. It is a harmless response to the drug, but the patient needs to be aware it may happen.
A)"Immunize your child against this disease."
B)"Seek medical attention for serious injuries."
C) "Report exposure to this illness."
D) "Avoid use of aspirin for viral infections."
The correct answer is D: "Avoid use of aspirin for viral infections."
The link between aspirin use and Reye''s Syndrome has not been confirmed, but evidence suggests that the risk is sufficiently grave to include the warning on aspirin products.
Potts, N.L. and Mandleco, B.L. (2002). Pediatric nursing, caring for children and their families.
Wong, D.L., Perry, S.E., & Hockenberry, M.J. (2002). Maternal Child Nursing. (2nd edition). Mosby:
8. The nurse is caring for a client who is 4 days post-op for a transverse colostomy. The client is ready for discharge and asks the nurse to empty his colostomy pouch. What is the best response by the nurse?
B)"Let me demonstrate to you how to empty the pouch."
C) "What have you learned about emptying your pouch?"
D) "Show me what you have learned about emptying your pouch.
The correct answer is D: "Show me what you have learned about emptying your pouch."
Most adult learners obtain skills by participating in the activities. Anxiety about discharge can be causing the client to forget that they have mastered the skill of emptying the pouch. The client should show the nurse how the pouch is emptied.
Delaune, S & Lander, P. (2002). Fundamentals in Nursing: Standards and Practice. (2nd ed).
9. A client with paranoid thoughts refuses to eat because of the belief that the food is poisoned. The appropriate statement at this time for the nurse to say is
A)"Here, I will pour a little of the juice in a medicine cup to drink it to show you that it is OK."
B) "The food has been prepared in our kitchen and is not poisoned."
C) "Let's see if your partner could bring food from home."
D) "If you don't eat, I will have to suggest for you to be tube fed."
The correct answer is C: "Let''s see if your partner could bring food from home."
Reassurance is ineffective when a client is actively delusional. This option avoids both arguing with the client and agreeing with the delusional premise. Option D offers a logical response to a primarily affective concern. When the client’s condition has improved, gentle negation of the delusional premise can be employed.
Fontaine, K.L. (2003). Mental Health Nursing, (5th ed.).
Varcarolis, E. (2002). Foundations of Psychiatry Mental Health Nursing A Clinical Approach (4th ed.).
10. A client has had a positive reaction to purified protein derivative (PPD). The client asks the nurse what this means. The nurse should indicate that the client has
A)active tuberculosis
B)been exposed to mycobacterium tuberculosis
C) never had tuberculosis
D) never been infected with mycobacterium tuberculosis
The PPD skin test is used to determine the presence of tuberculosis antibodies and a positive result indicates that the person has been exposed to mycobacterium tuberculosis. Additional tests are needed to determine if active tuberculosis is present.
Lewis, S.M., Heitkemper, M.M., & Dirksen, S. R. (2004). Medical-Surgical Nursing: Assessment & management of clinical problems.
11. A client diagnosed with cirrhosis is started on lactulose (Cephulac). The main purpose of the drug for this client is to
A) add dietary fiber
B) reduce ammonia levels
C)stimulate peristalsis
D) control portal hypertension
Lactulose blocks the absorption of ammonia from the GI tract and secondarily stimulates bowel elimination.
Deglin, J.D. and Vallerand, A.H. (2001).
Wilson, B.A., Shannon, M.T., and Stang, C.L. (2004). Nurse’s drug guide.
12. The nurse is teaching a client about the toxicity of digoxin. Which one of the following statements made by the client to the nurse indicates more teaching is needed?
A) "I may experience a loss of appetite."
B) "I can expect occasional double vision."
C) "Nausea and vomiting may last a few days."
D) "I must report a bounding pulse of 62 immediately."
Slow heart rate is related to increased cardiac output and an intended effect of digoxin. The ideal heart rate is above 60 BPM with digoxin. The client needs further teaching.
Deglin, J.D. and Vallerand, A.H. (2001).
13. A client is receiving a nitroglycerin infusion for unstable angina. What assessment would be a priority when monitoring the effects of this medication?
A) Blood pressure
B) Cardiac enzymes
C) ECG analysis
D) Respiratory rate
The correct answer is A: Blood pressure
Since an effect of this drug is vasodilation, the client must be monitored for hypotension.
Deglin, J.D. and Vallerand, A.H. (2001).
Key, J.L. and Hayes, E.R. (2003). Pharmacology, a nursing process approach. (4th edition).
14. In discharge teaching, the nurse should emphasize that which of these is a common side effect of clozapine (Clozaril) therapy?
A) Dry mouth
B) Rhinitis
C) Dry skin
D) Extreme salivation
A significant number of clients receiving Clozapine (Clozaril) therapy experience extreme salivation.
Deglin, J.D. and Vallerand, A.H. (2001).
Wilson, B.A., Shannon, M.T., and Stang, C.L. (2004). Nurse’s drug guide.
15. A client is admitted to the hospital with findings of liver failure with ascites. The health care provider orders spironolactone (Aldactone). What is the pharmacological effect of this medication?
A)Promotes sodium and chloride excretion
B) Increases aldosterone levels
C)Depletes potassium reserves
D) Combines safely with antihypertensives
Spironolactone promotes sodium and chloride excretion while sparing potassium and decreasing aldosterone levels. It had no effect on ammonia levels.
Deglin, J.D. and Vallerand, A.H. (2001).
B)"Your child may swim in your own pool but not in a lake or ocean."
C)"Your child may swim if he wears ear plugs."
D) "Your child may swim anywhere."
The correct answer is C: "Your child may swim if he wears ear plugs."
Water should not enter the ears. Children should use ear plugs when bathing or swimming and should not put their heads under the water.
Hockenberry, M.J.,
Potts, N.L. and Mandleco, B.L. (2002). Pediatric nursing, caring for children and their families.
B) Accept the client’s statement without comment
C) Tell the client that the comment is inappropriate
D) Leave the client's room
Exploring feelings with the verbally aggressive client helps to put angry feelings into words and then to engage in problem solving.
Condon, M.C. (2004). Women''s health, an integrated approach to wellness and illness.
A) "Use a sunscreen with a minimum sun protective factor of 15."
B) "Applications of sunscreen should be repeated every few hours."
C)"An infant should be protected by the maximum strength sunscreen."
D) "Sunscreens are not recommended in children younger than 6 months."
Infants under 6 months of age should be kept out of the sun or shielded from it. Even on a cloudy day, the infant can be sunburned while near water. A hat and light protective clothing should be worn
Potts, N.L. and Mandleco, B.L. (2002). Pediatric nursing, caring for children and their families.
A) Alteration in body image
B) High risk for infection
C) Altered growth and development
D) Impaired physical mobility
The correct answer is B: High risk for infection
Cyclosporin (Neoral) inhibits normal immune responses. Clients receiving cyclosporin are at risk for infection.
Deglin, J.D. and Vallerand, A.H. (2001).
Wilson, B.A., Shannon, M.T., and Stang, C.L. (2004). Nurse’s drug guide.
20. A post-operative client is admitted to the post-anesthesia recovery room (PACU). The anesthetist reports that malignant hyperthermia occurred during surgery. The nurse recognizes that this complication is related to what factor?
A) Allergy to general anesthesia
B) Pre-existing bacterial infection
C) A genetic predisposition
D) Selected surgical procedures
Malignant hyperthermia is a rare, potentially fatal adverse reaction to inhaled anesthetics. There is a genetic predisposition to this disorder.
Delaune, S & Lander, P. (2002). Fundamentals in Nursing: Standards and Practice. (2nd ed).
21. The nurse is caring for a client with a new order for bupropion (Wellbutrin) for treatment of depression. The order reads “Wellbutrin 175 mg. BID x 4 days.” What is the appropriate action?
A)Give the medication as ordered
B)Question this medication dose
C)Observe the client for mood swings
D) Monitor neuro signs frequently
Bupropion (Wellbutrin) should be started at 100mg BID for three days then increased to 150mg BID. When used for depression, it may take up to four weeks for results. Common side effects are dry mouth, headache, and agitation. Doses should be administered in equally spaced time increments throughout the day to minimize the risk of seizures.
A)"Your doctor will advise you about your risks."
B)"Unless you had previous problems, every 2 years is best."
C) "Once a woman reaches 50, she should have a mammogram yearly."
D) "Yearly mammograms are advised for all women over 35."
The American Cancer Society recommends a screening mammogram by age 40, every 1 - 2 years for women 40-49, and every year from age 50. If there are family or personal health risks, other assessments may be recommended.
Edelman, C.L. and Mandle, C.M. (2002). Health promotion throughout the lifespan. (5th edition).
A) Pain management
B) Restricted physical activity
C) Altered body image
D) Separation from family
The hospitalized adolescent may see each of these as a threat, but the major threat that they feel when hospitalized is the fear of altered body image, because of the emphasis on physical appearance during this developmental stage.
Weber, J., and Kelley, J. (2003). Health Assessment in Nursing. (2nd edition).
Wong, D.L., Perry, S.E., & Hockenberry, M.J. (2002). Maternal Child Nursing. (2nd edition). Mosby:
24. A client has many delusions. As the nurse helps the client prepare for breakfast the client comments "Don’t waste good food on me. I’m dying from this disease I have." The appropriate response would be
A) "You need some nutritious food to help you regain your weight."
B) "None of the laboratory reports show that you have any physical disease."
C) "Try to eat a little bit, breakfast is the most important meal of the day."
D) "I know you believe that you have an incurable disease."
This response does not challenge the client’s delusional system and thus forms an alliance by providing reassurance of desire to help the client.
Fontaine, K.L. (2003). Mental Health Nursing, (5th ed.).
B) High serum creatinine
C) Low serum albumin
D) Low serum blood urea nitrogen
The correct answer is B: High serum creatinine
An elevated serum creatinine indicates reduced renal function. Reduced renal function will delay the excretion of many mediations.
Deglin, J.D. and Vallerand, A.H. (2001).
Key, J.L. and Hayes, E.R. (2003). Pharmacology, a nursing process approach. (4th edition).
26. The feeling of trust can best be established by the nurse during the process of the development of a nurse-client relationship by which of these characteristics?
A)Reliability and kindness
B)Demeanor and sincerity
C)Honesty and consistency
D) Sympathy and appreciativeness
Characteristics of a trusting relationship include respect, honesty, consistency, faith and caring.
Potter P. and Perry, A. (2005). Fundamental of Nursing. (6th Edition).
Delaune, S & Lander, P. (2002). Fundamentals in Nursing: Standards and Practice. (2nd ed).
27. The nurse is beginning nutritional counseling/teaching with a pregnant woman. What is the initial step in this interaction?
B)Explain the changes in diet necessary for pregnant women
C) Question her understanding and use of the food pyramid
D) Conduct a diet history to determine her normal eating routines
Assessment is always the first step in planning teaching for any client. A thorough and accurate history is essential for gathering the needed information.
Condon, M.C. (2004). Women''s health, an integrated approach to wellness and illness.
A)"Your team here thinks it's good for you to spend time with others."
B) "It is important for you to participate in group activities."
C)"Come with me so you can paint a picture to help you feel better."
D) "Come play Chinese Checkers with Gloria and me."
This gradually engages the client in interactions with others in small groups rather than large groups. In addition, focusing on an activity is less anxiety-provoking than unstructured discussion. The statement is an example of a positive behavioral expectation.
Altman, G. (2004). Delmar’s Fundamental and Advanced Nursing Skills, 2nd ed. Albany, NY: Delmar.
A) Cocaine use can cause fetal growth retardation
B) The drug has been linked to neural tube defects
C) Newborn withdrawal generally occurs immediately after birth
D) Breast feeding promotes positive parenting behaviors
The correct answer is A: Cocaine use can cause fetal growth retardation
Cocaine is vasoconstrictive, and this effect in the placental vessels causes fetal hypoxia and diminished growth. Other risks of continued cocaine use during pregnancy include preterm labor, congenital abnormalities, altered brain development and subsequent behavioral problems in the infant.
Wong, D.L., Perry, S.E., & Hockenberry, M.J. (2002). Maternal Child Nursing. (2nd edition). Mosby:
A)"It is unsafe to abruptly stop taking any prescribed medication."
B)"Side effects and benefits should be discussed with your health care provider."
C)"This medication should be continued despite unpleasant symptoms."
D) "Many medications have potential side effects."
The correct answer is A: "It is unsafe to abruptly stop taking any prescribed medication."
Abrupt withdrawal may occasionally cause serotonin syndrome, consisting of lethargy, nausea, headache, fever, sweating and chills. A slow withdrawal may be prescribed with sertraline to avoid dizziness, nausea, vomiting, and diarrhea.
Deglin, J.D. and Vallerand, A.H. (2001).
Delaune, S & Lander, P. (2002). Fundamentals in Nursing: Standards and Practice. (2nd ed).
31. A nurse has administered several blood transfusions over 3 days to a 12 year-old client with Thalassemia. What lab value should the nurse monitor closely during this therapy?
A)Hemoglobin
B)Red Blood Cell Indices
C)Platelet count
D) Neutrophil percent
The correct answer is A: Hemoglobin
Hemoglobin should be in a therapeutic range of approximately 10 g/dl (100gL). "This level is low enough to foster the patient''s own erythropoiesis without enlarging the spleen." (Lewis, p. 744)
Lewis, S.M., Heitkemper, M.M., & Dirksen, S. R. (2004). Medical-Surgical Nursing: Assessment & management of clinical problems.
Hockenberry, M.J.,
32. A 12 year-old child is admitted with a broken arm and is told surgery is required. The nurse finds him crying and unwilling to talk. What is the most appropriate response by the nurse?
A)Give him privacy
B)Tell him he will get through the surgery with no problem
C) Try to distract him
D) Make arrangements for his friends to visit
The correct answer is A: Give him privacy
A 12 year-old child needs the opportunity to express his emotions privately.
Potts, N.L. and Mandleco, B.L. (2002). Pediatric nursing, caring for children and their families.
A)Calcium 9 mg/dl
B)Magnesium 2.5 mg/dl
C)Potassium 2.5 mEq/L
D) PTT 70 seconds
The patient is at risk for ventricular dysrhythmias when the potassium level is low.
Daniels, R. (2003). Delmar’s manual of laboratory and diagnostic tests.
Lewis, S.M., Heitkemper, M.M., & Dirksen, S. R. (2004). Medical-Surgical Nursing: Assessment & management of clinical problems.
A)Ambivalence, dependence, demanding
B)Denial, projection, regression
C) Intellectualization, rationalization, repression
D) Identification, assimilation, withdrawal
The correct answer is B: Denial, projection, regression
Helplessness and hopelessness may contribute to regressive, dependent behavior which often occurs at any age with hospitalization. Denying or minimizing the seriousness of the illness is used to avoid facing the worst situation. Recall that denial is the initial step in the process of working through any loss.
Hockenberry, M.J.,
35. The nurse is teaching a school-aged child and family about the use of inhalers prescribed for asthma. What is the best way to evaluate effectiveness of the treatments?
B) Use a peak-flow meter
C)Note skin color changes
D) Monitor pulse rate
The correct answer is B: Use a peak-flow meter
The peak flowmeter, if used correctly, shows effectiveness of inhalants.
Wong, D.L., Perry, S.E., & Hockenberry, M.J. (2002). Maternal Child Nursing. (2nd edition). Mosby:
Potts, N.L. and Mandleco, B.L. (2002). Pediatric nursing, caring for children and their families.
A)The child should carry a nasal spray for emergency use
B)The family must observe the child for dehydration
C)Parents should administer the daily intramuscular injections
D) The client needs to take daily injections in the short-term
The correct answer is A: The child should carry a nasal spray for emergency use
Diabetes insipidus results from reduced secretion of the antidiuretic hormone, vasopressin. The child will need to administer daily injections of vasopressin, and should have the nasal spray form of the medication readily available. A medical alert tag should be worn.
Deglin, J.D. and Vallerand, A.H. (2001).
Wong, D.L., Perry, S.E., & Hockenberry, M.J. (2002). Maternal Child Nursing. (2nd edition). Mosby:
A)Blood pressure
B)Liver function
C) Mental status
D) Hemoglobin
The elderly are at risk for developing confusion when taking cimetidine, a drug that interacts with many other medications.
Deglin, J.D. and Vallerand, A.H. (2001).
Wilson, B.A., Shannon, M.T., and Stang, C.L. (2004). Nurse’s drug guide.
38. The nurse has just received report on a group of clients and plans to delegate care of several of the clients to a practical nurse (PN). The first thing the RN should do before the delegation of care is
A)Provide a time-frame for the completion of the client care
B)Assure the PN that the RN will be available for assistance
C)Ask about prior experience with similar clients
D) Review the specific procedures unique to the assignment
The correct answer is C: Ask about prior experience with similar clients
The first step in delegation is to determine the qualifications of the person to whom one is delegating. By asking about the PN''s prior experience with similar clients/tasks, the RN can determine whether the PN has the requisite experience to care for the assigned clients
Zerwekh, J. and Claborn, J. (2003). Nursing Today. Transitions and Trends.
Black, J, Hawk, J, Keene, A. (2001). Medical-Surgical Nursing ( 6th ed).
B Obtain the regular blood glucose readings
C) Determine if special skin care is needed
D) Answer questions from the client's spouse about the plan of care
The UAP can safely obtain blood glucose readings, which are routine tasks.
Black, J, Hawk, J, Keene, A. (2001). Medical-Surgical Nursing ( 6th ed).
40. A client is to begin taking Fosamax. The nurse must emphasize which of these instructions to the client when taking this medication? "Take Fosamax
B) after meals."
C) with calcium."
D) with milk 2 hours after meals."
Fosamax should be taken first thing in the morning with 6-8 ounces of plain water at least 30 minutes before other medication or food. Food and fluids (other than water) greatly decrease the absorption of Fosamax. The client must also be instructed to remain in the upright position for 30 minutes following the dose to facilitate passage into the stomach and minimize irritation of the esophagus.
Deglin, J.D. and Vallerand, A.H. (2001).
Key, J.L. and Hayes, E.R. (2003). Pharmacology, a nursing process approach. (4th edition).
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