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1.   A  client  is admitted  to  the  emergency  room  with  a  gunshot  wound to  the  right  arm.  After  dressing  the  wound  and  administering  the prescribed  antibiotic,  the  nurse  should: 

❍ A.  Ask the client if he has any medication allergies  
❍ B.  Check the client’s immunization record  
❍ C.  Apply a splint to immobilize the arm  
❍ D.  Administer medication for pain 





2. The nurse is caring for a client with suspected endometrial cancer.   Which symptom  is  associated  with  endometrial  cancer? 

❍ A.  Frothy vaginal discharge  ❍ B.  Thick, white vaginal discharge 

 ❍ C.  Purulent vaginal discharge  

❍ D.  Watery vaginal discharge  





3.   A  client with Parkinson’s disease is scheduled for stereotactic sur gery.  Which  finding  indicates  that  the  surgery  had  its  intended effect? 

A.The  client  no  longer  has  intractable  tremors. 
B.The  client  has  sufficient  production  of  dopamine. 
C.The client  no  longer requires  any  medication. 
D.The  client  will  have  increased  production  of  serotonin. 






4.   A  client with AIDS  asks the nurse why he cannot have a  pitcher  of water  left  at  his  bedside.  The  nurse  should  tell  the client  that: 

A.It  would  be  best  for  him  to  drink  ice  water. 
B.He  should  drink  several  glasses  of  juice  instead. 
C.It  makes  it  easier to  keep  a  record  of  his  intake.
D.He  should  drink  only  freshly  run  water. 





5.  An  elderly  client  is  diagnosed  with  interstitial  cystitis.  Which  finding dif-ferentiates interstitial cystitis from other forms of cystitis?  
❍ A.  The client is asymptomatic.  
❍ B.  The urine is free of bacteria.  
❍ C.  The urine contains blood.  ❍ D.  Males are affected more often.  





6.  The mother  of  a male  child  with  cystic  fibrosis  tells  the  nurse  that  she hopes her son’s children won’t have the disease. The nurse is aware that:  

❍  A.  There  is  a  25%  chance  that  his  children  will  have cystic fibrosis. 
❍ B.  Most of the males with cystic fibrosis are sterile.  
❍ C.  There is a 50% chance that his children will be carriers.  
❍  D.  Most  males  with  cystic  fibrosis  are  capable  of  having chil-dren, so genetic counseling is advised.  





7.  A 6-month-old  is  hospitalized  with  symptoms  of  botulism.  What  aspect  of the infant’s history is associated with Clostridium botulinum infection?  

❍ A.  The infant sucks on his fingers and toes.  
❍ B.  The mother sweetens the infant’s cereal with honey.  
❍ C.  The infant was switched to soy-based formula.  
❍ D.  The father recently purchased an aquarium.  





8.  The  mother  of  a  6-year-old  with  autistic  disorder  tells  the  nurse  that her  son  has  been  much  more  difficult  to  care  for  since  the  birth  of  his sister. The best explanation for changes in the child’s behavior is: 

❍ A.  The child did not want a sibling.  
❍ B.  The child was not adequately prepared for the baby’s arrival.  
❍  C.  The  child’s  daily  routine  has  been  upset  by  the  birth of his sister. 
❍ D.  The child is just trying to get the parent’s attention.  





9.  The  parents  of  a  child  with  cystic  fibrosis  ask  what  determines the  prog-nosis  of  the  disease.  The  nurse  knows  that  the  greatest determinant of the prognosis is:  
❍ A.  The degree of pulmonary involvement 
❍ B.  The ability to maintain an ideal weight 
❍ C.  The secretion of lipase by the pancreas  
❍ D.  The regulation of sodium and chloride excretion  






10.  The  nurse  is  assessing  a  client  hospitalized  with  duodenal  ulcer. Which finding should be reported to the doctor immediately?  


A.  BP 82/60, pulse 120 


❍ B.  Pulse 68, respirations 24  ❍ C.  BP 110/88, pulse 56 

❍ D.  Pulse 82, respirations 16  







11.  While  caring  for  a  client  in  the  second  stage  of  labor,  the  nurse notices a pattern of early decelerations. The nurse should:  

❍ A.  Notify the physician immediately  
❍ B.  Turn the client on her left side  
❍ C.  Apply oxygen via a tight face mask  
❍ D.  Document the finding on the flow sheet  





12.  The  nurse  is  teaching  the  client  with  AIDS  regarding  needed changes  in  food  preparation.  Which  statement  indicates  that  the client understands the nurse’s teaching?  


❍  A.  ―Adding  fresh  ground  pepper  to  my  food  will improve the flavor.‖  
❍  B.  ―Meat  should  be  thoroughly  cooked  to  the proper temperature.‖ 
❍  C.  ―Eating  cheese  and  yogurt  will  prevent  AIDSrelated diarrhea.‖ 
❍  D.  ―It  is  important  to  eat  four  to  five  servings  of  fresh  fruits and vegetables a day.‖ 







13.  The  sputum  of  a  client  remains  positive  for  the  tubercle  bacillus  even though  the  client  has  been  taking  Laniazid  (isoniazid).  The  nurse  recognizes that the client should have a negative sputum culture within:  

❍ A.  2 weeks  
❍ B.  6 weeks  
❍ C.  8 weeks  
❍ D.  12 weeks  







14. Which person is at greatest risk for developing Lyme’s disease?  

❍ A.  Computer programmer  
❍ B.  Elementary teacher 
❍ C.  Veterinarian  
❍  D.   Landscaper   







15.  The  mother  of  a  1-year-old  wants  to  know  when  she  should  begin  toilettraining  her  child.  The  nurse’s  response  is  based  on  the  knowledge  that sufficient sphincter control for toilet training is present by:  

❍ A.  12–15 months of age 
❍ B.  18–24 months of age 
❍ C.  26–30 months of age 
❍ D.  32–36 months of age  




16.  The  nurse  is  developing  a  plan  of  care  for  a  client  with  an ileostomy. The priority nursing diagnosis is:  

❍ A.  Fluid volume deficit 
❍ B.  Alteration in body image  
❍ C.  Impaired oxygen exchange  
❍ D.  Alteration in elimination 






17.  The  physician  has  prescribed  Cobex  (cyanocobalamin)  for a client  follow-ing  a  gastric  resection.  Which  lab  result  indicates that the medication is having its intended effect?  

❍ A.  Neutrophil count of 4500  
❍ B.  Hgb of 14.2g 
❍ C.  Platelet count of 250,000  
❍ D.  Eosinophil count of 200  







18.  A behavior-modification  program  has  been  started  for an adolescent  with  oppositional  defiant  disorder.  Which  statement describes the use of behavior modification?  

❍  A.  Distractors  are  used  to  interrupt  repetitive  or unpleasant thoughts.  
❍  B.  Techniques  using  stressors  and  exercise  are  used  to increase awareness of body defenses.  
❍  C.  A  system  of  tokens  and  rewards  is  used  as  positive reinforce-ment. 
❍  D.  Appropriate  behavior  is  learned  through  observing  the action of models.  





19.  Following  eruption  of  the  primary  teeth,  the  mother can  promote chew-ing by giving the toddler:  

❍ A.  Pieces of hot dog  
❍ B.  Carrot sticks  
❍ C.  Pieces of cereal  
❍ D.  Raisins  





20.  The  nurse  is  infusing  total  parenteral  nutrition  (TPN).  The  primary pur-pose for closely monitoring the client’s intake and output is:  

❍  A.  To determine  how  quickly  the  client  is  metabolizing  the solu-tion  
❍ B.  To determine whether the client’s oral intake is sufficient  
❍ C.  To detect the development of hypovolemia  
❍ D.  To decrease the risk of fluid overload  












21.  An  obstetrical  client  with  diabetes  has  an  amniocentesis  at  28  weeks gestation. Which test indicates the degree of fetal lung maturity?  


❍ A.  Alpha-fetoprotein 

❍ B.  Estriol level  

❍ C.  Indirect Coomb’s  

❍ D.  Lecithin sphingomyelin ratio  







22.  Which  nursing  assessment  indicates  that  involutional  changes have occurred in a client who is 3 days postpartum?  

❍ A.  The fundus is firm and 3 finger widths below the umbilicus.  
❍ B.  The client has a moderate amount of lochia serosa.  
❍ C.  The fundus is firm and even with the umbilicus.  
❍ D.  The uterus is approximately the size of a small grapefruit.  






23.  When  administering  total  parenteral  nutrition,  the  nurse  should assess  the  client  for  signs  of  rebound  hypoglycemia.  The nurse knows that rebound hypoglycemia occurs when:  

❍ A.  The infusion rate is too rapid.  
❍ B.  The infusion is discontinued without tapering.  ❍ C.  The solution is infused through a peripheral line.  
❍ D.  The infusion is administered without a filter.





  
24.  A client  scheduled  for  disc  surgery  tells  the  nurse  that  she  frequently uses  the  herbal  supplement  kava-kava  (piper  methysticum).  The  nurse should notify the doctor because kava-kava:  

❍  A.  Increases  the  effects  of  anesthesia  and  postoperative analgesia  
❍  B.  Eliminates  the  need  for  antimicrobial  therapy following surgery  
❍  C.  Increases  urinary  output,  so  a  urinary  catheter will be needed post-operatively  ❍  D.  Depresses  the  immune  system,  so  infection  is more  of  a  problem   





25.  The  physician  has  ordered  50mEq  of  potassium  chloride  for  a client  with  a  potassium  level  of  2.5mEq.  The  nurse  should administer the medica-tion:  
❍ A.  Slow, continuous IV push over 10 minutes  
❍ B.  Continuous infusion over 30 minutes  
❍ C.  Controlled infusion over 5 hours  
❍ D.  Continuous infusion over 24 hours  






26.  The  nurse  reviewing  the  lab  results  of  a  client  receiving  Cytoxan (cyclophasphamide)  for  Hodgkin’s  lymphoma  finds  the  following:  WBC 4,200,  RBC  3,800,000,  platelets  25,000,  and  serum  creatinine  1.0mg. The nurse recognizes that the greatest risk for the client at this time is:  
❍ A.  Overwhelming infection  ❍ B.  Bleeding  
❍ C.  Anemia  
❍ D.  Renal failure  






27.  While  administering  a  chemotherapeutic  vesicant,  the  nurse  notes  that there is a lack of blood return from the IV catheter. The nurse should:  
❍ A.  Stop the medication from infusing  
❍ B.  Flush the IV catheter with normal saline  
❍ C.  Apply a tourniquet and call the doctor  
❍ D.  Continue the IV and assess the site for edema  





28.  A client  with  cervical  cancer has  a  radioactive  implant.  Which statement  indicates  that  the  client  understands  the  nurse’s teaching regarding radioactive implants?  

❍  A.  ―I  won’t  be  able  to  have  visitors  while  getting radiation therapy.‖  
❍ B.  ―I will have a urinary catheter while the implant is in place.‖ 
❍ C.  ―I can be up to the bedside commode while the implant is  in place.‖ 
❍ D.  ―I won’t have any side effects from this type of therapy.‖  





29.  The  nurse  is  teaching  circumcision  care  to  the  mother  of  a  newborn. Which statement indicates that the mother needs further teaching?  ❍  A.  ―I  will  apply  a  petroleum  gauze  to  the  area  with  each diaper change.‖  
❍ B.  ―I will clean the area carefully with each diaper change.‖  
❍  C.  ―I  can  place  a  heat  lamp  to  the  area  to  speed  up  the healing process.‖  
❍ D.  I should carefully observe the area for signs of infection.







30.  A client admitted for treatment of bacterial pneumonia has an order for   intravenous ampicillin. Which specimen should be obtained prior to    administering the medication?      

❍ A. Routine urinalysis     
❍ B. Complete blood count      
❍ C. Serum electrolytes     
❍  D.  Sputum for culture and sensitivity      








32.  A client with Hodgkin’s lymphoma is receiving Platinol (cisplatin). To help   prevent nephrotoxicity, the nurse should:    
❍ A. Slow the infusion rate      
❍ B. Make sure the client is well hydrated     
 ❍ C. Record the intake and output every shift     
❍  D.  Tell the client to report ringing in the ears      





33.  The chart of a client hospitalized for a total hip repair reveals that the   client is colonized with MRSA. The nurse understands that the client:   
❍ A.  Will not display symptoms of infection   
❍ B.  Is less likely to have an infection   
❍ C.  Can be placed in the room with others   
❍ D.  Cannot colonize others with MRSA   






34. A client receiving Vancocin (vancomycin) has a serum level of 20mcg/mL.  The nurse knows that the therapeutic range for vancomycin is:   

❍ A.  5–10mcg/mL   
❍ B.  10–25mcg/mL   
❍ C.  25–40mcg/mL   
❍ D.  40–60mcg/mL







35.  A  client  is  admitted  with  symptoms  of  pseudomembranous  colitis. Which finding is associated with Clostridium difficile?  

❍ A.  Diarrhea containing blood and mucus  
❍ B.  Cough, fever, and shortness of breath  
❍ C.  Anorexia, weight loss, and fever  
❍ D.  Development of ulcers on the lower extremities  






36.  Which  vitamin  should  be  administered  with  INH  (isoniazid)  in order to prevent possible nervous system side effects?  

❍ A.  Thiamine  
❍ B.  Niacin  
❍ C.  Pyridoxine  
❍ D.  Riboflavin  







37.  A  client  is  admitted  with  suspected  Legionnaires’  disease.  Which factor increases the risk of developing Legionnaires’ disease?  

❍ A.  Treatment of arthritis with steroids  
❍ B.  Foreign travel  
❍ C.  Eating fresh shellfish twice a week  
❍ D.  Doing volunteer work at the local hospital  






38.  A client  who  uses  a  respiratory  inhaler asks  the  nurse  to  explain how  he  can  know  when  half  his  medication  is  empty  so  that  he can refill his prescrip-tion. The nurse should tell the client to:  

❍ A.  Shake the inhaler and listen for the contents 
❍ B.  Drop the inhaler in water to see if it floats  
❍ C.  Check for a hissing sound as the inhaler is used  
❍ D.  Press the inhaler and watch for the mist  






39.  The  nurse  is  caring  for  a  client  following  a  right  nephrolithotomy. Post-operatively, the client should be positioned:  

❍ A.  On the right side  
❍ B.  Supine  
❍ C.  On the left side  
❍ D.  Prone  






40.  A  client  is  admitted  with  sickle  cell  crises  and  sequestration. Upon assessing the client, the nurse would expect to find:  

❍ A.  Decreased blood pressure  
❍ B.  Moist mucus membranes  
❍ C.  Decreased respirations  
❍ D.  Increased blood pressure





41.  A  healthcare  worker  is  referred  to  the  nursing  office  with  a  suspected latex allergy. The first symptom of latex allergy is usually:  

❍ A.  Oral itching after eating bananas  
❍ B.  Swelling of the eyes and mouth  
❍ C.  Difficulty in breathing  
❍ D.  Swelling and itching of the hands  









31.  While obtaining information about the client’s current medication use, the   nurse learns that the client takes ginkgo to improve mental alertness. The  nurse should tell the client to:      

❍ A. Report signs of bruising or bleeding to the doctor      

❍ B. Avoid sun exposure while using the herbal     

❍ C. Purchase only those brands with FDA approval      

❍  D.  Increase daily intake of vitamin E      











42.  A  client  is  admitted  with  disseminated  herpes  zoster.  According  to the Centers for Disease Control Guidelines for Infection Control:  

❍ A.  Airborne precautions will be needed.  

❍ B.  No special precautions will be needed.  

❍ C.  Contact precautions will be needed.  

❍ D.  Droplet precautions will be needed.  







43.  Acticoat  (silver  nitrate)  dressings  are  applied  to  the  legs  of  a client with deep partial thickness burns. The nurse should:  

❍ A.  Change the dressings once per shift 

❍ B.  Moisten the dressing with sterile water  

❍ C.  Change the dressings only when they become soiled  

❍ D.  Moisten the dressing with normal saline  







44.  The  nurse  is  preparing  to  administer  an  injection  to  a  6-month-old  when she notices a white dot in the infant’s right pupil. The nurse should:  

❍ A.  Report the finding to the physician immediately  

❍ B.  Record the finding and give the infant’s injection  

❍ C.  Recognize that the finding is a variation of normal  

❍ D.  Check both eyes for the presence of the red reflex  








45.  A  client  is  diagnosed  with  stage  II  Hodgkin’s  lymphoma.  The nurse rec-ognizes that the client has involvement:  

❍ A.  In a single lymph node or single site  ❍  B.  In  more  than  one  node  or  single  organ  on  the  same side of the diaphragm  ❍ C.  In lymph nodes on both sides of the diaphragm  ❍  D.   In  disseminated  organs  and  tissues






46.  A client  has  been receiving  Rheumatrex  (methotrexate)  for  severe rheumatoid arthritis. The nurse should tell the client to avoid taking:  


❍ A.  Aspirin  ❍ B.  Multivitamins  ❍ C.  Omega 3 fish oils  ❍ D.  Acetaminophen  







47.  The  physician  has  ordered  a  low-residue  diet  for  a  client  with  Crohn’s disease. Which food is not permitted in a low-residue diet?  


❍ A.  Mashed potatoes  ❍ B.  Smooth peanut butter  ❍ C.  Fried fish  ❍ D.  Rice  







48.  A client  hospitalized  with  cirrhosis  has  developed  abdominal  ascites.  The nurse should provide the client with snacks that provide additional:  ❍ A.  Sodium  ❍ B.  Potassium  ❍ C.  Protein  ❍ D.  Fat  






49.  A diagnosis  of  multiple  sclerosis  is  often  delayed  because  of  the varied  symptoms  experienced  by  those  affected  with  the  disease. Which symp-tom is most common in those with multiple sclerosis? 


❍ A.  Resting tremors  ❍ B.  Double vision  ❍ C.  Flaccid paralysis  ❍ D.  ―Pill-rolling‖ tremors 





  50.  After attending  a  company  picnic,  several  clients  are  admitted to  the  emergency  room  with  E.  coli  food  poisoning.  The  most likely source of infection is: 


❍ A.  Hamburger  ❍ B.  Hot dog  ❍ C.  Potato salad  ❍ D.  Baked beans






51.  A client  tells  the  nurse  that  she  takes  St.  John’s  wort  (hypericum perfora-tum)  three  times  a  day  for mild  depression.  The  nurse should tell the client that: 


❍ A.  St. John’s wort seldom relieves depression.  ❍ B.  She should avoid eating aged cheese.  ❍ C.  Skin reactions increase with the use of sunscreen.  ❍ D.  The herbal is safe to use with other antidepressants.






  



52.  The  physician  has  ordered  a  low-purine  diet  for a  client  with  gout. Which protein source is high in purine? 


❍ A.  Dried beans  ❍ B.  Nuts  ❍ C.  Cheese  ❍ D.  Eggs  





53.  The  nurse  is  observing  the  ambulation  of  a  client  recently  fitted for crutch-es. Which observation requires nursing intervention?  

❍  A.  Two finger  widths  are  noted  between  the  axilla  and  the top of the crutch.  

❍ B.  The client bears weight on his hands when ambulating.  

❍ C.  The crutches and the client’s feet move alternately.  ❍ D.  The client bears weight on his axilla when standing. 






54.  During  the  change  of  shift  report,  a  nurse  writes  in  her  notes that  she  suspects  illegal  drug  use  by  a  client  assigned  to  her care.  During  the  shift,  the  notes  are  found  by  the  client’s daughter. The nurse could be sued for: 


❍ A.  Libel  

❍ B.  Slander  

❍ C.  Malpractice  

❍ D.  Negligence  






55.  The  nurse  is  caring  for  an  adolescent  with  a  5-year  history  of bulimia. A common clinical finding in the client with bulimia is:  

❍ A.  Extreme weight loss 

❍ B.  Dental caries  

❍ C.  Hair loss  

❍  D.   Decreased  temperature






56.  A  client  hospitalized  for  treatment  of  congestive  heart  failure  is  to  be  discharged  with  a  prescription  for  Digitek  (digoxin)  0.25mg  daily.  Which  of the following statements indicates that the client needs further teaching? 

❍  A.  ―I  will  need  to  take  the  medication  at  the  same time each day.‖ 

❍  B.  ―I  can  prevent  stomach  upset  by  taking  the medication with an antacid.‖  ❍  C.  ―I  can  help  prevent  drug  toxicity  by  eating  foods containing fiber.‖  

❍ D.  ―I will need to report visual changes to my doctor.






57.  A  client  with  paranoid  schizophrenia  has  an  order  for Thorazine (chlor-promazine) 400mg orally twice daily.  Which  of  the  following  symptoms  should  be reported to the physician immediately? 

❍ A.  Fever, sore throat, weakness  

❍ B.  Dry mouth, constipation, blurred vision  

❍ C.  Lethargy, slurred speech, thirst  

❍ D.  Fatigue, drowsiness, photosensitivity  








58.  When  caring  for  a  client  with  an  anterior  cervical  discectomy, the  nurse  should  give  priority  to  assessing  for  post-operative bleeding. The nurse should pay particular attention to:  

❍ A.  Drainage on the surgical dressing  

❍ B.  Complaints of neck pain  ❍ C.  Bleeding from the mouth  ❍ D.  Swelling in the posterior neck  






59.  The  initial  assessment  of  a  newborn  reveals  a  chest circumference  of  34cm  and  an  abdominal  circumference  of 31cm.  The  chest  is  asymmetri-cal  and  breath  sounds  are diminished on the left side. The nurse should give priority to: 


❍ A.  Providing supplemental oxygen by a ventilated mask

❍  B.  Performing  auscultation  of  the  abdomen  for  the presence of active bowel sounds  
❍ C.  Inserting a nasogastric tube to check for esophageal patency  
❍ D.  Positioning on the left side with head and chest elevated








60.  The  physician  has  ordered  Eskalith  (lithium carbonate)  500mg  three times  a  day  and  Risperdal  (risperidone)  2mg  twice  daily  for  a  client admitted  with  bipolar  disorder,  acute  manic  episodes.  The  best explana-tion for the client’s medication regimen is:  


❍  A.  The  client’s  symptoms  of  acute  mania  are  typical  of undiag-nosed schizophrenia.  
❍  B. Antipsychotic  medication  is  used  to  manage  behavioral excitement until mood stabilization occurs.  
❍  C.  The  client  will  be  more  compliant  with  a  medication that allows some feelings of hypomania.  
❍  D.  Antipsychotic  medication  prevents  psychotic  symptoms com-monly associated with the use of mood stabilizers.  







61.  During  a  unit  card  game,  a  client  with  acute  mania  begins  to sing loudly as she starts to undress. The nurse should:  


❍ A.  Ignore the client’s behavior  
❍ B.  Exchange the cards for a checker board  
❍ C.  Send the other clients to their rooms  
❍ D.  Cover the client and walk her to her room  







62.  A child  with  Down  syndrome  has  a  developmental  age  of  4 years.  According  to  the  Denver Developmental  Assessment, the 4-year-old should be able to:  


❍ A.  Draw a man in six parts  
❍ B.  Give his first and last name  
❍ C.  Dress without supervision  
❍ D.  Define a list of words  







63.  A client  with  paranoid  schizophrenia  is  brought  to  the  hospital  by her  elderly  parents.  During  the  assessment,  the  client’s  mother states,  ―Sometimes  she  is  more  than  we  can  manage.‖  Based  on the mother’s statement, the most appropriate nursing diagnosis is:  


❍ A.  Ineffective family coping related to parental role conflict  
❍ B.  Care-giver role strain related to chronic situational stress  
❍ C.  Altered family process related to impaired social interaction  
❍  D.   Altered parenting  related  to  impaired  growth  and  development 







64.  An  adolescent  client  hospitalized  with  anorexia  nervosa  is described  by  her  parents  as  ―the  perfect  child.‖  When  planning care for the client, the nurse should:  
❍ A.  Allow her to choose what foods she will eat  
❍ B.  Provide activities to foster her self-identity  
❍ C.  Encourage her to participate in morning exercise  
❍ D.  Provide a private room near the nurse’s station  



 










65.  The  nurse  is  assigning  staff  to  care  for a  number of  clients  with emotion-al  disorders.  Which  facet  of  care  is  suitable  to  the  skills of the nursing assistant?  


❍  A.  Obtaining  the  vital  signs  of  a  client  admitted  for  alcohol with-drawal  ❍ B.  Helping a client with depression with bathing and grooming  ❍  C.  Monitoring  a  client  who  is  receiving electroconvulsive therapy 

❍ D.  Sitting with a client with mania who is in seclusion  





66.  A client  with  angina  is  being  discharged  with  a  prescription  for  Transderm Nitro (nitroglycerin) patches. The nurse should tell the client to:  


❍ A.  Shave the area before applying the patch❍ B.  Remove the old patch and clean the skin with alcohol  ❍ C.  Cover the patch with plastic wrap and tape it in place  ❍ D.  Avoid cutting the patch because it will alter the dose  







67.  A  client  with  myasthenia  gravis  is  admitted  in  a  cholinergic crisis. Signs of of cholinergic crisis include:  


❍ A.  Decreased blood pressure and constricted pupils  ❍ B.  Increased heart rate and increased respirations  ❍ C.  Increased respirations and increased blood pressure 

❍ D.  Anoxia and absence of the cough reflex  







68.  The  nurse  is  providing  dietary  teaching  for  a  client  with  hypertension. Which food should be avoided by the client on a sodium-restricted diet? 

 ❍ A.  Dried beans  ❍ B.  Swiss cheese  ❍ C.  Peanut butter  ❍ D.  Colby cheese  







69.  A client  is  admitted  to  the  emergency  room  with  partialthickness  burns  to  his  right  arm  and  full-thickness  burns  to  his trunk.  According  to  the  Rule  of  Nines,  the  nurse  calculates  that the total body surface area (TBSA) involved is:  


❍ A.  20%  ❍ B.  35%  ❍ C.  45%  ❍ D.  60%  







70.  The  physician  has  ordered  a  paracentesis  for  a  client  with  severe abdom-inal ascites. Before the procedure, the nurse should:  

❍ A.  Provide the client with a urinal  

❍ B.  Prep the area by shaving the abdomen  

❍ C.  Encourage the client to drink extra fluids  

❍ D.  Request an ultrasound of the abdomen  








71.  Which  of  the  following  combinations  of  foods  is  appropriate for a 6-month-old?

  ❍ A.  Cocoa-flavored cereal, orange juice, and strained meat  

❍ B.  Graham crackers, strained prunes, and pudding  ❍ C.  Rice cereal, bananas, and strained carrots  

❍ D.  Mashed potatoes, strained beets, and boiled egg  








72.  The  mother  of  a  9-year-old  with  asthma  has  brought  an  electric CD  play-er  for  her  son  to  listen  to  while  he  is  receiving  oxygen therapy. The nurse should:  

❍ A.  Explain that he does not need the added stimulation  

❍ B.  Allow the player, but ask him to wear earphones  

❍ C.  Tell the mother that he cannot have items from home  ❍ D.  Ask the mother to bring a battery-operated CD instead  





73.  Which  one  of  the  following  situations  represents  a  maturational crisis for the family?  

❍ A.  A 4-year-old entering nursery school

❍ B.  Development of preeclampsia during pregnancy  

❍ C.  Loss of employment and health benefits  

❍  D.   Hospitalization  of  a  grandfather with  a  stroke  









74.  A client  with  a  history  of  phenylketonuria  is  seen  at  the  local family  planning  clinic.  After  completing  the  client’s  intake  history, the  nurse  provides  litera-ture  for a  healthy  pregnancy.  Which statement indicates that the client needs further teaching? 

❍  A.  ―I  can  help  control  my  weight  by  switching  from sugar to Nutrasweet.‖  

❍ B.  ―I need to resume my old diet before becoming pregnant.‖  

❍  C.  ―Fresh  fruits  and  raw  vegetables  will  make  excellent between-meal snacks.‖  

❍  D.  ―I  need  to  eliminate  most  sources  of  phenylalanine from my diet.‖  








75.  Parents  of  a  toddler  are  dismayed  when  they  learn  that  their child  has  Duchenne’s  muscular dystrophy.  Which  statement describes the inheri-tance pattern of the disorder? 

❍ A.  An affected gene is located on 1 of the 21 pairs of autosomes.  ❍  B.  The  disorder  is  caused  by  an  over-replication  of  the  X chro-mosome in males.  ❍  C.  The  affected  gene  is  located  on  the  Y  chromosome of the father.  ❍  D.  The  affected  gene  is  located  on  the  X  chromosome of the mother.








  
76.  A client  with  obsessive  compulsive  personality  disorder  annoys  his  coworkers  with  his  rigid-perfectionistic  attitude  and  his  preoccupation  with trivial details. An important nursing intervention for this client would be:  


❍ A.  Helping the client develop a plan for changing his behavior  ❍ B.  Contracting with him for the time he spends on a task  ❍  C.  Avoiding  a  discussion  of  his  annoying  behavior because it will only make him worse  ❍  D.  Encouraging  him  to  set  a  time  schedule  and deadlines for himself  







77.  The  mother  of  a  child  with  chickenpox  wants  to  know  if  there  is  a med-ication  that  will  shorten  the  course  of  the  illness.  Which medication  is  sometimes  used  to  speed  healing  of  the  lesions and shorten the duration of fever and itching?  


❍ A.  Zovirax (acyclovir) 

❍ B.  Varivax (varicella vaccine)  ❍ C.  VZIG (varicella-zoster immune globulin) 

❍ D.  Periactin (cyproheptadine)   







78.  One  of  the  most  important  criteria  for  the  diagnosis  of  physical abuse  is  inconsistency  between  the  appearance  of  the  injury  and the  history  of  how  the  injury  occurred.  Which  one  of  the  following situations should alert the nurse to the possibility of abuse?  

❍  A.  An  18-month-old  with  sock  and  mitten  burns  from  a fall into the bathtub  ❍  B.  A  6-year-old  with  a  fractured  clavicle  following  a  fall from her bike  ❍  C.  An  8-year-old  with  a  concussion  from  a skateboarding accident ❍ D.  A 2-year-old with burns to the scalp and face from a  grease spill 







79.  A  patient  refuses  to  take  his  dose  of  oral  medication.  The  nurse  tells  the patient  that  if  he  does  not  take  the  medication  that  she  will  administer  it by injection. The nurse’s comments can result in a charge of:  


❍ A.  Malpractice  ❍ B.  Assault  ❍ C.  Negligence  ❍ D.  Battery  







80.  During  morning  assessments,  the  nurse  finds  that  a  client’s  nephrostomy tube has been clamped. The nurse’s first action should be to:  


❍ A.  Assess the drainage bag  ❍ B.  Check for bladder distention  ❍ C.  Unclamp the tubing 

❍ D.  Irrigate the tubing  








81.  The  nurse  caring  for  a  client  with  chest  tubes  notes  that  the Pleuravac’s collection chambers are full. The nurse should:  


❍ A.  Add more water to the suction-control chamber  ❍ B.  Remove the drainage using a 60mL syringe  ❍ C.  Milk the tubing to facilitate drainage  ❍ D.  Prepare a new unit for continuing collection  







82.  A client  with  severe  anemia  is  to  receive  a  unit  of  whole  blood.  In  the event of a transfusion reaction, the first action by the nurse should be to: 


❍ A.  Notify the physician and the nursing supervisor  ❍ B.  Stop the transfusion and maintain an IV of normal saline  ❍ C.  Call the lab for verification of type and cross match  ❍  D.   Prepare  an  injection  of  Benadryl  (diphenhydramine)  








 83.  A  new mother  tells  the  nurse  that  she  is  getting  a  new  microwave  so  that her husband can help prepare the baby’s feedings. The nurse should:  


❍  A.  Explain  that  a  microwave  should  never  be  used  to warm the baby’s bottles  ❍  B.  Tell  the  mother  that  microwaving  is  the  best  way  to prevent bacteria in the formula  ❍  C.  Tell  the  mother  to  shake  the  bottle  vigorously  for  1 minute after warming in the microwave  ❍  D.  Instruct  the  parents  to  always  leave  the  top  of  the  bottle open while microwaving so heat can escape  






84.  A  client  with  HELLP  syndrome  is  admitted  to  the  labor  and  delivery  unit for observation. The nurse knows that the client will have elevated:  


❍ A.  Serum glucose levels  ❍ B.  Liver enzymes  ❍ C.  Pancreatic enzymes 

❍ D.  Plasma protein levels  








85.  To  reduce  the  possibility  of  having  a  baby  with  a  neural  tube defect,  the  client  should  be  told  to  increase  her  intake  of  folic acid. Dietary sources of folic acid include:  


❍ A.  Meat, liver, eggs  ❍ B.  Pork, fish, chicken 

❍ C.  Spinach, beets, cantaloupe  ❍ D.  Dried beans, sweet potatoes, Brussels sprouts 








 

86.  The  nurse  is  making  room  assignments  for  four  obstetrical  clients.  If only one private room is available, it should be assigned to:  


❍ A.  A multigravida with diabetes mellitus  ❍ B.  A primigravida with preeclampsia  ❍ C.  A multigravida with preterm labor  ❍ D.  A primigravida with hyperemesis gravidarum  






87.  A  client  has  a  tentative  diagnosis  of  myasthenia  gravis.  The nurse recog-nizes that myasthenia gravis involves:  


❍  A.  Loss  of  the  myelin  sheath  in  portions  of  the  brain  and spinal cord  ❍  B.  An  interruption  in  the  transmission  of  impulses  from nerve endings to muscles  ❍  C.  Progressive  weakness  and  loss  of  sensation  that begins in the lower extremities  ❍ D.  Loss of coordination and stiff ―cogwheel‖ rigidity   







88.  The  physician  has  ordered  an  infusion  of  Osmitrol  (mannitol)  for a  client  with  increased  intracranial  pressure.  Which  finding indicates the direct effectiveness of the drug?  


❍ A.  Increased pulse rate 

❍ B.  Increased urinary output  ❍ C.  Decreased diastolic blood pressure  ❍ D.  Increased pupil size 






89.  The  nurse  has  just  received  the  change  of  shift  report. Which client should the nurse assess first?  


❍ A.  A client with a supratentorial tumor awaiting surgery  
❍ B.  A client admitted with a suspected subdural hematoma  
❍ C.  A client recently diagnosed with akinetic seizures  
❍ D.  A client transferring to the neuro rehabilitation unit  






90.  The  physician  has  ordered  an  IV  bolus  of  Solu-Medrol  (methylprednisolone  sodium  succinate)  in  normal  saline  for  a  client  admitted  with  a spinal cord injury. Solu-Medrol has been shown to be effective in:  


❍ A.  Preventing spasticity associated with cord injury  
❍ B.  Decreasing the need for mechanical ventilation  
❍ C.  Improving motor and sensory functioning 

❍ D.  Treating post injury urinary tract infections  







91.  The  physician  has  ordered  a  lumbar  puncture  for  a  client  with suspected  Guillain-Barre  syndrome.  The  spinal  fluid  of  a  client with Guillain-Barre syndrome typically shows:  


❍ A.  Decreased protein concentration with a normal cell count  
❍ B.  Increased protein concentration with a normal cell count  
❍ C.  Increased protein concentration with an abnormal cell count  
❍ D.  Decreased protein concentration with an abnormal cell count  






92.  An  18-month-old  is  admitted  to  the  hospital  with  acute laryngotracheo-bronchitis.  When  assessing  the  respiratory status, the nurse should expect to find:  


❍ A.  Inspiratory stridor and harsh cough  
❍ B.  Strident cough and drooling  
❍ C.  Wheezing and intercostal retractions  
❍  D.   Expiratory  wheezing  and  nonproductive  cough






93.  The  school  nurse  is  assessing  an  elementary  student  with  hemophilia who fell during recess. Which symptoms indicate hemarthrosis?  


❍ A.  Pain, coolness, and blue discoloration in the affected joint  
❍  B.  Tingling  and  pain  without  loss  of  movement  in  the affected joint  
❍  C.  Warmth,  redness,  and  decreased  movement  in  the affected joint  
❍  D.  Stiffness,  aching,  and  decreased  movement  in  the affected joint  







94.  The  physician  has  ordered  aerosol  treatments,  chest  percussion, and  postural  drainage  for  a  client  with  cystic  fibrosis.  The  nurse recognizes that the combination of therapies is to: 

 
❍ A.  Decrease respiratory effort and mucous production  
❍ B.  Increase efficiency of the diaphragm and gas exchange  
❍ C.  Dilate the bronchioles and help remove secretions  
❍ D.  Stimulate coughing and oxygen consumption 







95.  The  nurse  is  assessing  a  6-year-old  following  a  tonsillectomy.  Which one of the following signs is an early indication of hemorrhage?  


❍ A.  Drooling of bright red secretions  
❍ B.  Pulse rate of 90  
❍ C.  Vomiting of dark brown liquid  
❍ D.  Infrequent swallowing while sleeping  







96.  A  client  is  admitted  for  suspected  bladder  cancer.  Which  one  of  the following factors is most significant in the client’s diagnosis?  


❍ A.  Smoking a pack of cigarettes a day for 30 years  
❍ B.  Use of nonsteroidal anti-inflammatories  
❍ C.  Eating foods with preservatives  
❍ D.  Past employment involving asbestos  





97.  The  nurse  is  teaching  a  client  with  peritoneal  dialysis  how  to manage  exchanges  at  home.  The  nurse  should  tell  the  client  to notify the doctor immediately if: 

❍ A.  The dialysate returns become cloudy in appearance.  
❍ B.  The return of the dialysate is slower than usual.  
❍ C.  A ―tugging‖ sensation is noted as the dialysate drains.  
❍ D.  A feeling of fullness is felt when the dialysate is installed 




98.  The  physician  has prescribed  nitroglycerin  sublingual  tablets  as needed  for  a  client  with  angina.  The  nurse  should  tell  the  client to take the med-ication:  


❍ A.  After engaging in strenuous activity  
❍ B.  Every 4 hours to prevent chest pain  
❍ C.  As soon as he notices signs of chest pain 

❍ D.  At bedtime to prevent nocturnal angina 






99.  The  nurse  is  caring  for  a  client  following  a  myocardial  infarction. Which of the following enzymes are specific to cardiac damage?  


❍ A.  SGOT and LDH  
❍ B.  SGOT and CK BB  
❍ C.  LDH and CK MB  
❍ D.  LDH and CK BB  

100.  Which  of  the  following  characterizes  peer group  relationships  in 8- and 9-year-olds?  


❍ A.  Activities organized around competitive games  
❍ B.  Loyalty and strong same-sex friendships  
❍ C.  Informal socialization between boys and girls  
❍ D.  Shared activities with one best friend  





           



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