Pre-Board Nursing Exam for June 2013 NLE
by Admin · May 12, 2013
This Pre-Board Nursing Exam contains 100 questions. Both questions and answers were arranged randomly.
Topics that are included were: Foundation of Nursing, Nursing Research, Professional Adjustment, Leadership and Management, Maternal and Child Health, Community Health Nursing, Communicable Diseases, Integrated Management of Childhood Illness, Medical and Surgical Nursing and Psychiatric Nursing.
Pre-Board Exam for June 2013 NLE
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Question 1 |
Gigi has just underwent amniotomy. The nurse’s first action should be to assess the:
A | Degree of cervical dilation |
B | Fetal heart tones |
C | Client’s vital signs |
D | Client’s level of discomfort |
Question 1 Explanation:
ANSWER: Fetal heart tones ; RATIONALE: When the membranes rupture, there is often a transient drop in the fetal heart tones. The heart tones should return to baseline quickly. Any alteration in fetal heart tones, such as bradycardia or tachycardia, should be reported. After the fetal heart tones are assessed, the nurse should evaluate the cervical dilation, vital signs, and level of discomfort, making answers A, C, and D incorrect.
Question 2 |
The doctor orders Celebrex (celecoxib) for a client with osteoarthritis. Which instruction should be included in the discharge teaching?
A | Take the medication with milk. |
B | Report chest pain. |
C | Remain upright after taking for 30 minutes. |
D | Allow 6 weeks for optimal effects. |
Question 2 Explanation:
ANSWER: Report chest pain. ; RATIONALE: Cox II inhibitors have been associated with heart attacks and strokes. Any changes in cardiac status or signs of a stroke should be reported immediately, along with any changes in bowel or bladder habits because bleeding has been linked to use of Cox II inhibitors. The client does not have to take the medication with milk, remain upright, or allow 6 weeks for optimal effect, so answers A, C, and D are incorrect.
Question 3 |
Which of the following is the best area for auscultating the apical pulse?
A | Aortic arch |
B | Pulmonic area |
C | Tricuspid area |
D | Mitral area |
Question 3 Explanation:
ANSWER: Mitral area ; RATIONALE: The mitral area (also known as the left ventricular area or the apical area), the fifth intercostal space (ICS) at the left midclavicular line, is the best area for auscultating the apical pulse. The aortic arch is the second ICS to the right of sternum. The pulmonic area is the second intercostal space to the left of the sternum. The tricuspid area is the fifth ICS to the left of the sternum.
Question 4 |
Nurse Gigi is conducting health teaching to the family of a client with percutaneous gastronomy tube. Which statement made by the family member caring for this patient indicates understanding?
A | “I must flush the tube with water after feedings and clamp the tube.” |
B | “I must check placement four times per day.” |
C | “I will report to the doctor any signs of indigestion.” |
D | “If my father is unable to swallow, I will discontinue the feeding and call the clinic.” |
Question 4 Explanation:
ANSWER: “I must flush the tube with water after feedings and clamp the tube.” ; RATIONALE: The client’s family member should be taught to flush the tube after each feeding and clamp the tube. The placement should be checked before feedings, and indigestion can occur with the PEG tube, just as it can occur with any client, so answers B and C are incorrect. Medications can be ordered for indigestion, but it is not a reason for alarm. A percutaneous endoscopy gastrostomy tube is used for clients who have experienced difficulty swallowing. The tube is inserted directly into the stomach and does not require swallowing; therefore, answer D is incorrect.
Question 5 |
The nurse is suspected of charting medication administration that he did not give. After talking to the nurse, the charge nurse should:
A | Call the Board of Nursing |
B | File a formal reprimand |
C | Terminate the nurse |
D | Charge the nurse with a tort |
Question 5 Explanation:
ANSWER: File a formal reprimand ; RATIONALE: The next action after discussing the problem with the nurse is to document the incident by filing a formal reprimand. If the behavior continues or if harm has resulted to the client, the nurse may be terminated and reported to the Board of Nursing, but these are not the first actions requested in the stem. A tort is a wrongful act to the client or his belongings and is not indicated in this instance. Therefore, Answers A, C, and D are incorrect.
Question 6 |
Aida, gravida 3 para 0 is admitted to the labor and delivery unit. The doctor performs an amniotomy. Which observation would the nurse be expected to make after the amniotomy?
A | Fetal heart tones 160bpm |
B | A moderate amount of straw-colored fluid |
C | A small amount of greenish fluid |
D | A small segment of the umbilical cord |
Question 6 Explanation:
ANSWER: A moderate amount of straw-colored fluid ; RATIONALE: An amniotomy is an artificial rupture of membranes and normal amniotic fluid is straw-colored and odorless. Fetal heart tones of 160 indicate tachycardia, and greenish fluid is indicative of meconium, so answers A and C are incorrect. If the nurse notes the umbilical cord, the client is experiencing a prolapsed cord, so answer D is incorrect and would need to be reported immediately.
Question 7 |
Nurse Ivy is assigned to care for a client admitted with epiglottitis. She knows that patients with epiglottitis have the possibility of complete obstruction of the airway. In line with this, which of the following should the nurse have available?
A | Intravenous access supplies |
B | A tracheostomy set |
C | Intravenous fluid administration pump |
D | Supplemental oxygen |
Question 7 Explanation:
ANSWER: A tracheostomy set ; RATIONALE: For a child with epiglottitis and the possibility of complete obstruction of the airway, emergency tracheostomy equipment should always be kept at the bedside. Intravenous supplies, fluid, and oxygen will not treat an obstruction; therefore, answers A, C, and D are incorrect.
Question 8 |
Mila is assigned to a patient who has undergone percutaneous transhepatic cholangiography. which assessment finding indicates complication after the operation?
A | Fever and chills |
B | Hypertension |
C | Bradycardia |
D | Nausea and diarrhea |
Question 8 Explanation:
ANSWER: Fever and chills ; RATIONALE: Septicemia is a common complication after a percutaneous transhepatic cholangiography. Evidence of fever and chills, possibly indicative of septicemia, is important. Hypotension, not hypertension, is associated with septicemia. Tachycardia, not bradycardia, is most likely to occur. Nausea and diarrhea may occur but are not classic signs of sepsis.
Question 9 |
When providing dietary instructions to a mother of an 8-year-old child diagnosed with celiac disease, which of the following foods, if selected by the mother, would indicate her understanding of the dietary instructions?
A | Ham sandwich on whole-wheat toast |
B | Spaghetti and meatballs |
C | Hamburger with ketchup |
D | Cheese omelet |
Question 9 Explanation:
ANSWER: Cheese omelet ; RATIONALE: The child with celiac disease should be on a gluten-free diet. Answers A, B, and C all contain gluten, while answer D gives the only choice of foods that does not contain gluten.
Question 10 |
Which instruction would be included in the teaching plan for a patient who is currently taking antacids?
A | “Take the antacids with 8 oz of water.” |
B | “Avoid taking other medications within 2 hours of this one.” |
C | “Continue taking antacids even when pain subsides.” |
D | “Weigh yourself daily when taking this medication.” |
Question 10 Explanation:
ANSWER: “Avoid taking other medications within 2 hours of this one.” ; RATIONALE: Antacids neutralize gastric acid and decrease the absorption of other medications. The client should be instructed to avoid taking other medications within 2 hours of the antacid. Water, which dilutes the antacid, should not be taken with antacid. A histamine receptor antagonist should be taken even when pain subsides. Daily weights are indicated if the client is taking a diuretic, not an antacid.
Question 11 |
According to a health teaching conducted at the community, beginning in their 20s, women should be told about the benefits and limitations of breast self-exam (BSE). Which scientific rationale should the nurse remember when performing a breast examination on a female client?
A | One half of all breast cancer deaths occur in women ages 35 to 45 |
B | The tail of Spence area must be included in self-examination |
C | The position of choice for the breast examination is supine |
D | A pad should be placed under the opposite scapula of the breast being palpated |
Question 11 Explanation:
ANSWER: The tail of Spence area must be included in self-examination ; RATIONALE: The tail of Spence, an extension of the upper outer quadrant of breast tissue, can develop breast tumors. This area must also be included in breast self-examination. One half of all women who die of breast cancer are older than age 65. The correct position for breast self-examination is not limited to the supine position; the sitting position with hands at sides, above head, and on the hips is also recommended. A pad is placed under the ipsilateral (e.g., same side) scapula of the breast being palpated.
Question 12 |
Which intervention should the nurse include in the care plan for a client who has been diagnosed with acute pancreatitis?
A | Administration of vasopressin and insertion of a balloon tamponade |
B | Preparation for a paracentesis and administration of diuretics |
C | Maintenance of nothing-by-mouth status and insertion of nasogastric (NG) tube with low intermittent suction |
D | Dietary plan of a low-fat diet and increased fluid intake to 2,000 ml/day |
Question 12 Explanation:
ANSWER: Maintenance of nothing-by-mouth status and insertion of nasogastric (NG) tube with low intermittent suction ; RATIONALE: With acute pancreatitis, the client is kept on nothing-by-mouth status to inhibit pancreatic stimulation and secretion of pancreatic enzymes. NG intubation with low intermittent suction is used to relieve nausea and vomiting, decrease painful abdominal distention, and remove hydrochloric acid. Vasopressin would be appropriate for a client diagnosed with bleeding esophageal varices. Paracentesis and diuretics would be appropriate for a client diagnosed with portal hypertension and ascites. A low-fat diet and increased fluid intake would further aggravate the pancreatitis.
Question 13 |
Nurse Loida is about to perform Romberg’s test. To ensure the latter’s safety, which intervention should the nurse in charge?
A | Allowing the client to keep his eyes open |
B | Having the client hold on to furniture |
C | Letting the client spread his feet apart |
D | Standing close to provide support |
Question 13 Explanation:
ANSWER: Standing close to provide support ; RATIONALE: During Romberg’s test, the client is asked to stand with feet together and eyes shut and still maintain balance with the minimum of sway. If the client loses his balance, the nurse standing close to provide support, such as having an arm close around his shoulder, can prevent a fall. Allowing the client to keep his eyes open, spread his feet apart, or hang on to a piece of furniture interferes with the proper execution of the test and yields invalid results.
Question 14 |
Ron is admitted to the hospital for an open reduction internal fixation of a fractured hip. Immediately following surgery, the nurse should give priority to assessing the:
A | Serum collection (Davol) drain |
B | Client’s pain |
C | Nutritional status |
D | Immobilizer |
Question 14 Explanation:
ANSWER: Serum collection (Davol) drain ; RATIONALE: Bleeding is a common complication of orthopedic surgery. The blood-collection device should be checked frequently to ensure that the client is not hemorrhaging. The client’s pain should be assessed, but this is not life-threatening. When the client is in less danger, the nutritional status should be assessed and an immobilizer is not used; thus, answers B, C, and D are incorrect.
Question 15 |
In patient assignment, which nurse should be assigned to care for the postpartum client with preeclampsia?
A | The RN with 2 weeks of experience in postpartum |
B | The RN with 3 years of experience in labor and delivery |
C | The RN with 10 years of experience in surgery |
D | The RN with 1 year of experience in the neonatal intensive care unit |
Question 15 Explanation:
ANSWER: The RN with 3 years of experience in labor and delivery ; RATIONALE: The nurse with 3 years of experience in labor and delivery knows the most about possible complications involving preeclampsia. The nurse in answer A is a new nurse to the unit, and the nurses in answers C and D have no experience with the postpartum client.
Question 16 |
The nurse performs a vaginal exam to a client who is admitted to the labor and delivery unit and determines that the client’s cervix is 5 cm dilated with 75% effacement. Based on the nurse’s assessment the client is in which phase of labor?
A | Active |
B | Latent |
C | Transition |
D | Early |
Question 16 Explanation:
ANSWER: Active ; RATIONALE: The active phase of labor occurs when the client is dilated 4–7cm. The latent or early phase of labor is from 1cm to 3cm in dilation, so answers B and D are incorrect. The transition phase of labor is 8–10cm in dilation, making answer C incorrect.
Question 17 |
Physical assessment is being performed to Geoff by Nurse Tine. During the abdominal examination, Tine should perform the four physical examination techniques in which sequence?
A | Auscultation immediately after inspection and then percussion and palpation |
B | Percussion, followed by inspection, auscultation, and palpation |
C | Palpation of tender areas first and then inspection, percussion, and auscultation |
D | Inspection and then palpation, percussion, and auscultation |
Question 17 Explanation:
ANSWER: Auscultation immediately after inspection and then percussion and palpation ; RATIONALE: With an abdominal assessment, auscultation always is performed before percussion and palpation because any abdominal manipulation, such as from palpation or percussion, can alter bowel sounds. Percussion should never precede inspection or auscultation, and any tender or painful areas should be palpated last.
Question 18 |
It’s another toxic day at the emergency room. Currently, the ER is flooded with clients injured in a tornado. Which clients can be assigned to share a room in the emergency department during the disaster?
A | A schizophrenic client having visual and auditory hallucinations and the client with ulcerative colitis |
B | The client who is 6 months pregnant with abdominal pain and the client with facial lacerations and a broken arm |
C | A child whose pupils are fixed and dilated and his parents, and a client with a frontal head injury |
D | The client who arrives with a large puncture wound to the abdomen and the client with chest pain |
Question 18 Explanation:
ANSWER: The client who is 6 months pregnant with abdominal pain and the client with facial lacerations and a broken arm ; RATIONALE: The pregnant client and the client with a broken arm and facial lacerations are the best choices for placing in the same room. The clients in answers A, C, and D need to be placed in separate rooms due to the serious natures of their injuries.
Question 19 |
Upon scanning the charts during endorsement, Nurse Ina notes that one patient has a plaster-of-Paris case. Which action by the nurse indicates understanding of a plaster-of-Paris cast? The nurse:
A | Handles the cast with the fingertips |
B | Petals the cast |
C | Dries the cast with a hair dryer |
D | Allows 24 hours before bearing weight |
Question 19 Explanation:
ANSWER: Allows 24 hours before bearing weight ; RATIONALE: A plaster-of-Paris cast takes 24 hours to dry, and the client should not bear weight for 24 hours. The cast should be handled with the palms, not the fingertips, so answer A is incorrect. Petaling a cast is covering the end of the cast with cast batting or a sock, to prevent skin irritation and flaking of the skin under the cast, making answer B incorrect. The client should be told not to dry the cast with a hair dryer because this causes hot spots and could burn the client. This also causes unequal drying; thus, answer C is incorrect.
Question 20 |
Which of the following nursing interventions should be expected to be undertaken when caring for a 2-year-old toddler?
A | Ask the parent/guardian to leave the room when assessments are being performed. |
B | Ask the parent/guardian to take the child’s favorite blanket home because anything from the outside should not be brought into the hospital. |
C | Ask the parent/guardian to room-in with the child. |
D | If the child is screaming, tell him this is inappropriate behavior. |
Question 20 Explanation:
ANSWER: Ask the parent/guardian to room-in with the child. ; RATIONALE: The nurse should encourage rooming-in to promote parent-child attachment. It is okay for the parents to be in the room for assessment of the child. Allowing the child to have items that are familiar to him is allowed and encouraged; therefore, answers A and B are incorrect. Answer D is not part of the nurse’s responsibilities.
Question 21 |
Based on what she has learned in nursing school, Jennie understands that assessment plays a big role in client care.Which assessment finding indicates that lactulose is effective in decreasing the ammonia level in the client with hepatic encephalopathy?
A | Passage of two or three soft stools daily |
B | Evidence of watery diarrhea |
C | Daily deterioration in the client’s handwriting |
D | Appearance of frothy, foul-smelling stools |
Question 21 Explanation:
ANSWER: Passage of two or three soft stools daily ; RATIONALE: Lactulose reduces serum ammonia levels by inducing catharsis, subsequently decreasing colonic pH and inhibiting fecal flora from producing ammonia from urea. Ammonia is removed with the stool. Two or three soft stools daily indicate effectiveness of the drug. Watery diarrhea indicates overdose. Daily deterioration in the client’s handwriting indicates an increase in the ammonia level and worsening of hepatic encephalopathy. Frothy, foul-smelling stools indicate steatorrhea, caused by impaired fat digestion.
Question 22 |
Chloe is tasked to assist the staff nurse assigned to her patient in performing physical assessment with a 19-year-old client. Which assessment examination requires Chloe and the nurse to wear gloves?
A | Breast |
B | Integumentary |
C | Ophthalmic |
D | Oral |
Question 22 Explanation:
ANSWER: Oral ; RATIONALE: Gloves should be worn any time there is a risk of exposure to the client’s blood or body fluids. Oral, rectal, and genital examinations require gloves because they involve contact with body fluids. Ophthalmic, breast, or integumentary examinations normally do not involve contact with the client’s body fluids and do not require the nurse to wear gloves for protection. However, if there are areas of skin breakdown or drainage, gloves should be used.
Question 23 |
In providing patient care, Gina knows that nurses must work with other members of the healthcare team. In observing several healthcare workers providing care, which action by the healthcare worker indicates a need for further teaching?
A | The nursing assistant wears gloves while giving the client a bath. |
B | The nurse wears goggles while drawing blood from the client. |
C | The doctor washes his hands before examining the client. |
D | The nurse wears gloves to take the client’s vital signs. |
Question 23 Explanation:
ANSWER: The nurse wears gloves to take the client’s vital signs. ; RATIONALE: It is not necessary to wear gloves to take the vital signs of the client. If the client has active infection with methicillin-resistant staphylococcus aureus, gloves should be worn. The health care workers in answers A, B, and C indicate knowledge of infection control by their actions.
Question 24 |
Edwin is assisting an LPN and RN who are caring for a patient with a Steinmann pin. During pin care, she notes that the LPN uses sterile gloves and Q-tips to clean the pin. Which action should the nurse take at this time?
A | Assisting the LPN with opening sterile packages and peroxide |
B | Telling the LPN that clean gloves are allowed |
C | Telling the LPN that the registered nurse should perform pin care |
D | Asking the LPN to clean the weights and pulleys with peroxide |
Question 24 Explanation:
ANSWER: Assisting the LPN with opening sterile packages and peroxide ; RATIONALE: The nurse is performing the pin care correctly when she uses sterile gloves and Q-tips. A licensed practical nurse can perform pin care, there is no need to clean the weights, and the nurse can help with opening the packages but it isn’t required; therefore, answers B, C, and D are incorrect.
Question 25 |
A client elects to have epidural anesthesia to In order to relieve the discomfort of labor. Following the initiation of epidural anesthesia, the nurse should give priority to:
A | Checking for cervical dilation |
B | Placing the client in a supine position |
C | Checking the client’s blood pressure |
D | Obtaining a fetal heart rate |
Question 25 Explanation:
ANSWER: Checking the client’s blood pressure; RATIONALE: Following epidural anesthesia, the client should be checked for hypotension and signs of shock every 5 minutes for 15 minutes. The client can be checked for cervical dilation later after she is stable. The client should not be positioned supine because the anesthesia can move above the respiratory center and the client can stop breathing. Fetal heart tones should be assessed after the blood pressure is checked. Therefore, answers A, B, and D are incorrect.
Question 26 |
Matt has always considered himself as “indestructible” until he got admitted, diagnosed with dehydration and underwent series of tests. Which laboratory result would warrant immediate intervention by the nurse?
A | Serum sodium level of 138 mEq/L |
B | Serum potassium level of 3.1 mEq/L |
C | Serum glucose level of 120 mg/dl |
D | Serum creatinine level of 0.6 mg/100 ml |
Question 26 Explanation:
ANSWER: Serum potassium level of 3.1 mEq/L ; RATIONALE: A normal potassium level is 3.5 to 5.5 mEq/L. A normal sodium level is 135 to 145 mEq/L, a normal nonfasting glucose level is 85 to 140 mg/dl, and a normal creatinine level is 0.2 to 0.8 mg/100 ml.
Question 27 |
After the doctor’s rounds, the nurse noted that Spironolactone (Aldactone) is prescribed for a client with chronic cirrhosis and ascites. Nurse Ada should monitor the client for which of the following medication-related side effects?
A | Jaundice |
B | Hyperkalemia |
C | Tachycardia |
D | Constipation |
Question 27 Explanation:
ANSWER: Hyperkalemia ; RATIONALE: This is a potassium-sparing diuretic so clients should be monitored closely for hyperkalemia. Diarrhea, dizziness, and headaches are other more common side effects. Tachycardia, jaundice, and constipation are not expected side effects of spironolactone (Aldactone).
Question 28 |
Which of the following statements is true regarding balanced skeletal traction? Balanced skeletal traction:
A | Utilizes a Steinman pin |
B | Requires that both legs be secured |
C | Utilizes Kirschner wires |
D | Is used primarily to heal the fractured hips |
Question 28 Explanation:
ANSWER: Utilizes a Steinman pin ; RATIONALE: Balanced skeletal traction uses pins and screws. A Steinman pin goes through large bones and is used to stabilize large bones such as the femur. Answer B is incorrect because only the affected leg is in traction. Kirschner wires are used to stabilize small bones such as fingers and toes, as in answer C. Answer D is incorrect because this type of traction is not used for fractured hips.
Question 29 |
Nurse Gio is making a care plan. Which of the following should he include in the care plan for a client hospitalized with viral hepatitis?
A | Increase fluid intake to 3000 ml per day |
B | Adequate bed rest |
C | Bland diet |
D | Administer antibiotics as ordered |
Question 29 Explanation:
ANSWER: Adequate bed rest ; RATIONALE: Treatment of hepatitis consists of bed rest during the acute phase to reduce metabolic demands on the liver, thus increasing blood supply and cell regeneration. Forcing fluids, antibiotics, and bland diets are not part of the treatment plan for viral hepatitis.
Question 30 |
Nurse Aida is assigned to care for a 73-year old patient admitted at the unit and is diagnosed with pneumonia. Which data would be of greatest concern to the nurse when completing the nursing assessment of the patient?
A | Alert and oriented to date, time, and place |
B | Buccal cyanosis and capillary refill greater than 3 seconds |
C | Clear breath sounds and nonproductive cough |
D | Hemoglobin concentration of 13 g/dl and leukocyte count 5,300/mm3 |
Question 30 Explanation:
ANSWER: Buccal cyanosis and capillary refill greater than 3 seconds ; RATIONALE: Buccal cyanosis and capillary refill greater than 3 seconds are indicative of decreased oxygen to the tissues, which requires immediate intervention. Alert and oriented, clear breath sounds, nonproductive cough, hemoglobin concentration of 13 g/dl, and leukocyte count of 5,300/mm3 are normal data.
Question 31 |
In the assessment of lower extremities for arterial function, which intervention should the nurse perform?
A | Assessing the medial malleoli for pitting edema |
B | Performing Allen’s test |
C | Assessing the Homans’ sign |
D | Palpating the pedal pulses |
Question 31 Explanation:
ANSWER: Palpating the pedal pulses ; RATIONALE: Palpating the client’s pedal pulses assists in determining if arterial blood supply to the lower extremities is sufficient. Assessing the medial malleoli for pitting edema is appropriate for assessing venous function of the lower extremity. Allen’s test is used to evaluate arterial blood flow before inserting an arterial line in an upper extremity or obtaining arterial blood gases. Homans’ sign is used to evaluate the possibility of deep vein thrombosis.
Question 32 |
The doctor orders for discharge to the patient with hepatitis A. When planning home care which preventive measure should be emphasized to protect the client’s family?
A | Keeping the client in complete isolation |
B | Using good sanitation with dishes and shared bathrooms |
C | Avoiding contact with blood-soiled clothing or dressing |
D | Forbidding the sharing of needles or syringes |
Question 32 Explanation:
ANSWER: Using good sanitation with dishes and shared bathrooms ; RATIONALE: Hepatitis A is transmitted through the fecal oral route or from contaminated water or food. Measures to protect the family include good handwashing, personal hygiene and sanitation, and use of standard precautions. Complete isolation is not required. Avoiding contact with blood-soiled clothing or dressings or avoiding the sharing of needles or syringes are precautions needed to prevent transmission of hepatitis B.
Question 33 |
When discussing meal planning with the mother of a 2-year-old toddler, which of the following statements, if made by the mother, would require a need for further instruction?
A | “It is okay to give my child white grape juice for breakfast.” |
B | “My child can have a grilled cheese sandwich for lunch.” |
C | “We are going on a camping trip this weekend, and I have bought hot dogs to grill for his lunch.” |
D | “For a snack, my child can have ice cream.” |
Question 33 Explanation:
ANSWER: “We are going on a camping trip this weekend, and I have bought hot dogs to grill for his lunch.” ; RATIONALE: Remember the ABCs (airway, breathing, circulation) when answering this question. Answer C because a hotdog is the size and shape of the child’s trachea and poses a risk of aspiration. Answers A, B, and C are incorrect because white grape juice, a grilled cheese sandwich, and ice cream do not pose a risk of aspiration for a child.
Question 34 |
Tywin has come to the nursing clinic for a comprehensive health assessment. Which statement would be the best way to end the history interview?
A | “What brought you to the clinic today?” |
B | “Would you describe your overall health as good?” |
C | “Do you understand what is happening?” |
D | “Is there anything else you would like to tell me?” |
Question 34 Explanation:
ANSWER: “Is there anything else you would like to tell me?” ; RATIONALE: By asking the client if there is anything else, the nurse allows the client to end the interview by discussing feelings and concerns. Asking about what brought the client to the clinic is an ambiguous question to which the client may answer “my car” or any similarly disingenuous reply. Asking if the client describes his overall health as good is a leading question that puts words in his mouth. Asking if the client understands what is happening is a yes-or-no question that can elicit little information.
Question 35 |
Nurse Heidi is catering a patent with jaundice and who is also experiencing pruritus. Which nursing intervention would be included in the care plan for the client?
A | Administering vitamin K subcutaneously |
B | Applying pressure when giving I.M. injections |
C | Decreasing the client’s dietary protein intake |
D | Keeping the client’s fingernails short and smooth |
Question 35 Explanation:
ANSWER: Keeping the client’s fingernails short and smooth ; RATIONALE: The client with pruritus experiences itching, which may lead to skin breakdown and possibly infection from scratching. Keeping his fingernails short and smooth helps prevent skin breakdown and infection from scratching. Applying pressure when giving I.M. injections and administering vitamin K subcutaneously are important if the client develops bleeding problems. Decreasing the client’s dietary intake is appropriate if the client’s ammonia levels are increased.
Question 36 |
After a tonsillectomy of a child, which of the following should be considered as priority nursing diagnosis:
A | Body image disturbance |
B | Impaired verbal communication |
C | Risk for aspiration |
D | Pain |
Question 36 Explanation:
ANSWER: Risk for aspiration ; RATIONALE: Always remember your ABCs (airway, breathing, circulation) when selecting an answer. Although answers B and D might be appropriate for this child, answer C should have the highest priority. Answer A does not apply for a child who has undergone a tonsillectomy.
Question 37 |
What would be the most appropriate intervention Nurse Judy should perform for a 64-year-old client scheduled for surgery with a general anesthetic and who refuses to remove a set of dentures prior to leaving the unit for the operating room.
A | Explain to the client that the dentures must come out as they may get lost or broken in the operating room |
B | Ask the client if there are second thoughts about having the procedure |
C | Notify the anesthesia department and the surgeon of the client’s refusal |
D | Ask the client if the preference would be to remove the dentures in the operating room receiving area |
Question 37 Explanation:
ANSWER: Ask the client if the preference would be to remove the dentures in the operating room receiving area ; RATIONALE: Clients anticipating surgery may experience a variety of fears. This choice allows the client control over the situation and fosters the client’s sense of self-esteem and self-concept.
Question 38 |
In delegating assignments, which client should be assigned to the pregnant nurse?
A | The client receiving linear accelerator radiation therapy for lung cancer |
B | The client with a radium implant for cervical cancer |
C | The client who has just been administered soluble brachytherapy for thyroid cancer |
D | The client who returned from placement of iridium seeds for prostate cancer |
Question 38 Explanation:
ANSWER: The client receiving linear accelerator radiation therapy for lung cancer ; RATIONALE: The pregnant nurse should not be assigned to any client with radioactivity present. The client receiving linear accelerator therapy travels to the radium department for therapy. The radiation stays in the department, so the client is not radioactive. The clients in answers B, C, and D pose a risk to the pregnant nurse. These clients are radioactive in very small doses, especially upon returning from the procedures. For approximately 72 hours, the clients should dispose of urine and feces in special containers and use plastic spoons and forks.
Question 39 |
All of the following physical changes of the head and face are associated with the aging client except:
A | pronounced wrinkles on the face. |
B | decreased size of the nose and ears. |
C | increased growth of facial hair. |
D | neck wrinkles. |
Question 39 Explanation:
ANSWER: decreased size of the nose and ears. ; RATIONALE: The nose and ears of the aging client actually become longer and broader. The chin line is also altered. Wrinkles on the face become more pronounced and tend to take on the general mood of the client over the years. For example laugh or frown wrinkles about the eyebrows, lips, cheeks, and outer edges of the eye orbit. The change in the androgen-estrogen ratio causes an increase in growth of facial hair in most older adults. The aging process shortens the platysma muscle, which contributes to neck wrinkles.
Question 40 |
Osteoporosis has been discussed in class today. Based on what she has learned, Eva knows that for a 60-year-old female client, her susceptibility to osteoporosis is most likely related to:
A | Lack of exercise |
B | Hormonal disturbances |
C | Lack of calcium |
D | Genetic predisposition |
Question 40 Explanation:
ANSWER: Hormonal disturbances ; RATIONALE: After menopause, women lack hormones necessary to absorb and utilize calcium. Doing weight-bearing exercises and taking calcium supplements can help to prevent osteoporosis but are not causes, so answers A and C are incorrect. Body types that frequently experience osteoporosis are thin Caucasian females, but they are not most likely related to osteoporosis, so answer D is incorrect.
Question 41 |
Nurse Via is currently assigned at the Emergency Room. In the middle of her shift, an elderly client is admitted to the ER. Which symptom is the client with a fractured hip most likely to exhibit?
A | Pain |
B | Disalignment |
C | Cool extremity |
D | Absence of pedal pulses |
Question 41 Explanation:
ANSWER: Disalignment ; RATIONALE: The client with a hip fracture will most likely have misalignment. Answers A, C, and D are incorrect because all fractures cause pain, and coolness of the extremities and absence of pulses are indicative of compartment syndrome or peripheral vascular disease.
Question 42 |
When planning room assignments for the day, which client should be assigned to a private room if only one is available?
A | The client with Cushing’s disease |
B | The client with diabetes |
C | The client with acromegaly |
D | The client with myxedema |
Question 42 Explanation:
ANSWER: The client with Cushing’s disease ; RATIONALE: The client with Cushing’s disease has adrenocortical hypersecretion. This increase in the level of cortisone causes the client to be immunosuppressed. In answer B, the client with diabetes poses no risk to other clients. The client in answer C has an increase in growth hormone and poses no risk to himself or others. The client in answer D has hyperthyroidism or myxedema and poses no risk to others or himself.
Question 43 |
Which assessment data should the nurse include when obtaining a review of body systems
A | Brief statement about what brought the client to the health care provider |
B | Client complaints of chest pain, dyspnea, or abdominal pain |
C | Information about the client’s sexual performance and preference |
D | The client’s name, address, age, and phone number |
Question 43 Explanation:
ANSWER: Client complaints of chest pain, dyspnea, or abdominal pain ; RATIONALE: Client complaints about chest pain, dyspnea, or abdominal pain are considered part of the review of body systems. This potion of the assessment elicits subjective information on the client’s perceptions of major body system functions, including cardiac, respiratory, and abdominal. The client’s name, address, age, and phone number are biographical data. A brief statement about what brought the client to the health care provider is the chief complaint. Information about the client’s sexual performance and preference addresses past health status.
Question 44 |
Jerry, a 52-year old patient has been referred to the client due to increased abdominal girth, and is then diagnosed with ascites by the presence of a fluid thrill and shifting dullness on percussion. After administering diuretic therapy, which nursing action would be most effective to be taken by the nurse in ensuring safe care?
A | Measuring serum potassium for hyperkalemia |
B | Assessing the client for hypervolemia |
C | Measuring the client’s weight weekly |
D | Documenting precise intake and output |
Question 44 Explanation:
ANSWER: Documenting precise intake and output ; RATIONALE: For the client with ascites receiving diuretic therapy, careful intake and output measurement is essential for safe diuretic therapy. Diuretics lead to fluid losses, which if not monitored closely and documented, could place the client at risk for serious fluid and electrolyte imbalances. Hypokalemia, not hyperkalemia, commonly occurs with diuretic therapy. Because urine output increases, a client should be assessed for hypovolemia, not hypervolemia. Weights are also an accurate indicator of fluid balance. However, for this client, weights should be obtained daily, not weekly.
Question 45 |
Jelly is reading all about otoscopic examination. During this procedure, which action should be avoided to prevent the client from discomfort and injury?
A | Tipping the client’s head away from the examiner and pulling the ear up and back |
B | Inserting the otoscope inferiorly into the distal portion of the external canal |
C | Inserting the otoscope superiorly into the proximal two-thirds of the external canal |
D | Bracing the examiner’s hand against the client’s head |
Question 45 Explanation:
ANSWER: Inserting the otoscope superiorly into the proximal two-thirds of the external canal ; RATIONALE: In the superior position, the speculum of the otoscope is nearest the tympanic membrane, and the most sensitive portion of the external canal is the proximal two-thirds. It is important to avoid these structures during the examination. Tipping the client’s head away from the examiner, pulling the ear up and back, inserting the otoscope inferiorly, and bracing the examiner’s hand against the client’s head are all appropriate techniques used during an otoscopic examination.
Question 46 |
In evaluating the effectiveness of IV Pitocin for a client with secondary dystocia, the nurse should expect:
A | A painless delivery |
B | Cervical effacement |
C | Infrequent contractions |
D | Progressive cervical dilation |
Question 46 Explanation:
ANSWER: Progressive cervical dilation ; RATIONALE: The expected effect of Pitocin is cervical dilation. Pitocin causes more intense contractions, which can increase the pain, making answer A incorrect. Cervical effacement is caused by pressure on the presenting part, so answer B is incorrect. Answer C is opposite the action of Pitocin.
Question 47 |
Which of the following time periods would the nurse notify the health care provider that the client had no bowel sounds?
A | 2 minutes |
B | 3 minutes |
C | 4 minutes |
D | 5 minutes |
Question 47 Explanation:
ANSWER: 5 minutes ; RATIONALE: To completely determine that bowel sounds are absent, the nurse must auscultate each of the four quadrants for at least 5 minutes; 2, 3, or 4 minutes is too short a period to arrive at this conclusion.
Question 48 |
Which equipment would assist the client with a total hip replacement with activities of daily living?
A | High-seat commode |
B | Recliner |
C | TENS unit |
D | Abduction pillow |
Question 48 Explanation:
ANSWER: High-seat commode ; RATIONALE: The equipment that can help with activities of daily living is the high-seat commode. The hip should be kept higher than the knee. The recliner is good because it prevents 90° flexion but not daily activities. A TENS (Transcutaneous Electrical Nerve Stimulation) unit helps with pain management and an abduction pillow is used to prevent adduction of the hip and possibly dislocation of the prosthesis; therefore, answers B, C, and D are incorrect.
Question 49 |
Nurse Jillian is caring for a male patient who has chronic pain, loss of self-esteem, no job, and bodily disfigurement from severe burns over the trunk and arms, is admitted to a pain center. Which evaluation criteria would indicate the client’s successful rehabilitation?
A | The client remains free of the aftermath phase of the pain experience. |
B | The client experiences decreased frequency of acute pain episodes. |
C | The client continues normal growth and development with intact support systems. |
D | The client develops increased tolerance for severe pain in the future. |
Question 49 Explanation:
ANSWER: The client continues normal growth and development with intact support systems. ; RATIONALE: Even though the client may experience an aftermath phase, progress is still possible, as is effective rehabilitation. Aftermath reactions may occur but need not interfere with rehabilitation. Acute pain is not expected at this stage of recovery. Conditioning probably would produce less pain tolerance.
Question 50 |
The folks had been asking the nurse about the procedure recently performed to their patient. Which rationale supports explaining the placement of an esophageal tamponade tube in a client who is hemorrhaging?
A | Allowing the client to help insert the tube |
B | Beginning teaching for home care |
C | Maintaining the client’s level of anxiety and alertness |
D | Obtaining cooperation and reducing fear |
Question 50 Explanation:
ANSWER: Obtaining cooperation and reducing fear ; RATIONALE: An esophageal tamponade tube would be inserted in critical situations. Typically, the client is fearful and highly anxious. The nurse therefore explains about the placement to help obtain the client’s cooperation and reduce his fear. This type of tube is used only short term and is not indicated for home use. The tube is large and uncomfortable. The client would not be helping to insert the tube. A client’s anxiety should be decreased, not maintained, and depending on the degree of hemorrhage, the client may not be alert.
Question 51 |
When providing health teaching to a 51-year-old woman who is diagnosed with cholecystitis, which diet, when selected by the client, indicates that the nurse’s teaching has been successful?
A | 4-6 small meals of low-carbohydrate foods daily |
B | High-fat, high-carbohydrate meals |
C | Low-fat, high-carbohydrate meals |
D | High-fat, low protein meals |
Question 51 Explanation:
ANSWER: Low-fat, high-carbohydrate meals ; RATIONALE: For the client with cholecystitis, fat intake should be reduced. The calories from fat should be substituted with carbohydrates. Reducing carbohydrate intake would be contraindicated. Any diet high in fat may lead to another attack of cholecystitis.
Question 52 |
In health teaching, which instruction should be given to the mother regarding the medication of a child with enterobiasis?
A | Treatment is not recommended for children less than 10 years of age. |
B | The entire family should be treated. |
C | Medication therapy will continue for 1 year. |
D | Intravenous antibiotic therapy will be ordered. |
Question 52 Explanation:
ANSWER: The entire family should be treated. ; RATIONALE: Enterobiasis, or pinworms, is treated with Vermox (mebendazole) or Antiminth (pyrantelpamoate). The entire family should be treated to ensure that no eggs remain. Because a single treatment is usually sufficient, there is usually good compliance. The family should then be tested again in 2 weeks to ensure that no eggs remain. Answers A, C, and D are incorrect statements.
Question 53 |
A 5-year-old client has been admitted at the private pavilion with a diagnosis of plumbism. Which information in the health history is most likely related to the development of plumbism?
A | The client has traveled out of the country in the last 6 months. |
B | The client’s parents are skilled stained-glass artists. |
C | The client lives in a house built in 1 |
D | The client has several brothers and sisters. |
Question 53 Explanation:
ANSWER: The client’s parents are skilled stained-glass artists. ; RATIONALE: Plumbism is lead poisoning. One factor associated with the consumption of lead is eating from pottery made in Central America or Mexico that is unfired. The child lives in a house built after 1976 (this is when lead was taken out of paint), and the parents make stained glass as a hobby. Stained glass is put together with lead, which can drop on the work area, where the child can consume the lead beads. Answer A is incorrect because simply traveling out of the country does not increase the risk. In answer C, the house was built after the lead was removed with the paint. Answer D is unrelated to the stem.
Question 54 |
An 80-year-old patient diagnosed with chronic bronchitis is admitted at the unit. Upon the morning rounds, the nurse finds an O2 sat of 76%. Which of the following actions should the nurse take first?
A | Notify the physician |
B | Recheck the O2 saturation level in 15 minutes |
C | Apply oxygen by mask |
D | Assess the child’s pulse |
Question 54 Explanation:
ANSWER: Apply oxygen by mask ; RATIONALE: Remember the ABCs (airway, breathing, circulation) when answering this question. Before notifying the physician or assessing the pulse, oxygen should be applied to increase the oxygen saturation, so answers A and D are incorrect. The normal oxygen saturation for a child is 92%–100%, making answer B incorrect.
Question 55 |
Nurse Geed is caring for a client with hepatic cirrhosis and who has altered clotting mechanisms. Which intervention would be most important?
A | Allowing complete independence of mobility |
B | Applying pressure to injection sites |
C | Administering antibiotics as prescribed |
D | Increasing nutritional intake |
Question 55 Explanation:
ANSWER: Applying pressure to injection sites ; RATIONALE: The client with cirrhosis who has altered clotting is at high risk for hemorrhage. Prolonged application of pressure to injection or bleeding sites is important. Complete independence may increase the client’s potential for injury, because an unsupervised client may injure himself and bleed excessively. Antibiotics and good nutrition are important to promote liver regeneration. However, they are not most important for a client at high risk for hemorrhage.
Question 56 |
When obtaining information from a client in the emergency department, which should be considered as an example of biographic information that may be obtained during a health history?
A | The chief complaint |
B | Past health status |
C | History immunizations |
D | Location of an advance directive |
Question 56 Explanation:
ANSWER: Location of an advance directive ; RATIONALE: Biographic information may include name, address, gender, race, occupation, and location of a living will or a durable power of attorney for health care. The chief complaint, past health status, and history of immunizations are part of assessing the client’s health and illness patterns.
Question 57 |
Which of the following behavior indicates appropriate adaptation when evaluating a client’s adaptation to pain?
A | The client distracts himself during pain episodes. |
B | The client denies the existence of any pain. |
C | The client reports no need for family support. |
D | The client reports pain reduction with decreased activity. |
Question 57 Explanation:
ANSWER: The client distracts himself during pain episodes. ; RATIONALE: Distraction is an appropriate method of reducing pain. Denying the existence of any pain is inappropriate and not indicative of coping. Exclusion of family members and other sources of support represents a maladaptive response. Range-of-motion exercises and at least mild activity, not decreased activity, can help reduce pain and are important to prevent complications of immobility.
Question 58 |
Today at the ward, patient X is scheduled for a physical assessment. When percussing the client’s chest, the nurse would expect to find which assessment data as a normal sign over his lungs?
A | Dullness |
B | Resonance |
C | Hyperresonance |
D | Tympany |
Question 58 Explanation:
ANSWER: Resonance ; RATIONALE: Normally, when percussing a client’s chest, percussion over the lungs reveals resonance, a hollow or loud, low-pitched sound of long duration. Tympany is typically heard on percussion over such areas as a gastric air bubble or the intestine. Dullness is typically heard on percussion of solid organs, such as the liver or areas of consolidation. Hyperresonance would be evidenced by percussion over areas of overinflation such as an emphysematous lungs.
Question 59 |
Today in Geny’s class, they were discussing all about pancreatic function. After the lesson, she understands that pancreatic lipase performs which function?
A | Transports fatty acids into the brush border |
B | Breaks down fat into fatty acids and glycerol |
C | Triggers cholecystokinin to contract the gallbladder |
D | Breaks down protein into dipeptides and amino acids |
Question 59 Explanation:
ANSWER: Breaks down fat into fatty acids and glycerol ; RATIONALE: Lipase hydrolyses or breaks down fat into fatty acids and glycerol. Lipase is not involved with the transport of fatty acids into the brush border. Fat itself triggers cholecystokinin release. Protein breakdown into dipeptides and amino acids is the function of trypsin, not lipase.
Question 60 |
What would the nurse expect the admitting assessment to reveal in a pediatric client who has bacterial pneumonia?
A | High fever |
B | Nonproductive cough |
C | Rhinitis |
D | Vomiting and diarrhea |
Question 60 Explanation:
ANSWER: High fever ; RATIONALE: If the child has bacterial pneumonia, a high fever is usually present. Bacterial pneumonia usually presents with a productive cough, not a nonproductive cough, making answer B incorrect. Rhinitis is often seen with viral pneumonia, and vomiting and diarrhea are usually not seen with pneumonia, so answers C and D are incorrect.
Question 61 |
Right after rounds, patient X complains of abdominal pain that ranks 9 on a scale of 1 (no pain) to 10 (worst pain). Which interventions should the nurse implement? (Select all that apply.)
A | Assessing the client’s bowel sounds |
B | Taking the client’s blood pressure and apical pulse |
C | Obtaining a pulse oximeter reading |
D | Notifying the health care provider |
E | Determining the last time the client received pain medication |
F | Encouraging the client to turn, cough, and deep breathe |
Question 61 Explanation:
ANSWER: Assessing the client’s bowel sounds ; Taking the client’s blood pressure and apical pulse ; Determining the last time the client received pain medication ; RATIONALE: The nurse must rule out complications prior to administering pain medication, so her interventions would include assessing to make sure the client has bowel sounds and determining if the client is hemorrhaging by checking the client’s blood pressure and pulse. The nurse must also make sure the pain medication is due according to the health care provider’s orders. Obtaining a pulse oximeter reading and turning, coughing, and deep breathing will not help the client’s pain. There is no need to notify the health care provider in this situation.
Question 62 |
Which nursing intervention would be most helpful when addressing a client with chronic pancreatitis?
A | Allowing liberalized fluid intake |
B | Counseling to stop alcohol consumption |
C | Encouraging daily exercise |
D | Modifying dietary protein |
Question 62 Explanation:
ANSWER: Counseling to stop alcohol consumption ; RATIONALE: Chronic pancreatitis typically results from repeated episodes of acute pancreatitis. More than half of chronic pancreatitis cases are associated with alcoholism. Counseling to stop alcohol consumption would be the most helpful for the client. Dietary protein modification is not necessary for chronic pancreatitis. Daily exercise and liberalizing fluid intake would be helpful but not the most beneficial intervention.
Question 63 |
Peter is currently studying for his exams and is reading about the concept of pain. Which scientific rationale would indicate that he understands the topic?
A | Pain is an objective sign of a more serious problem |
B | Pain sensation is affected by a client’s anticipation of pain |
C | Intractable pain may be relieved by treatment |
D | Psychological factors rarely contribute to a client’s pain perception |
Question 63 Explanation:
ANSWER: Pain sensation is affected by a client’s anticipation of pain ; RATIONALE: Phases of pain experience include the anticipation of pain. Fear and anxiety affect a person’s response to sensation and typically intensify the pain. Intractable pain is moderate to severe pain that cannot be relieved by any known treatment. Pain is a subjective sensation that cannot be quantified by anyone except the person experiencing it. Psychological factors contribute to a client’s pain perception. In many cases, pain results from emotions, such as hostility, guilt, or depression.
Question 64 |
Mr. Smith, an elderly client with an abdominal surgery is admitted to the unit following surgery. In anticipation of complications of anesthesia and narcotic administration, the nurse should:
A | Administer oxygen via nasal cannula |
B | Have narcan (naloxone) available |
C | Prepare to administer blood products |
D | Prepare to do cardio resuscitation |
Question 64 Explanation:
ANSWER: Have narcan (naloxone) available ; RATIONALE: Narcan is the antidote for narcotic overdose. If hypoxia occurs, the client should have oxygen administered by mask, not cannula. There is no data to support the administration of blood products or cardiac resuscitation, so answers A, C, and D are incorrect.
Question 65 |
Which finding by the nurse indicates that the traction is working properly in a 2-year-old patient who has been admitted for repair of a fractured femur and is placed in Bryant’s traction?
A | The infant no longer complains of pain. |
B | The buttocks are 15° off the bed. |
C | The legs are suspended in the traction. |
D | The pins are secured within the pulley. |
Question 65 Explanation:
ANSWER: The buttocks are 15° off the bed. ; RATIONALE: The infant’s hips should be off the bed approximately 15° in Bryant’s traction. Answer A is incorrect because this does not indicate that the traction is working correctly, nor does C. Answer D is incorrect because Bryant’s traction is a skin traction, not a skeletal traction.
Question 66 |
Today in class, pan-control measures have been discussed. Which statement represents the best rationale for using noninvasive and non-pharmacologic pain-control measures in conjunction with other measures?
A | These measures are more effective than analgesics. |
B | These measures decrease input to large fibers. |
C | These measures potentiate the effects of analgesics. |
D | These measures block transmission of type C fiber impulses. |
Question 66 Explanation:
ANSWER: These measures potentiate the effects of analgesics. ; RATIONALE: Noninvasive measures may result in release of endogenous molecular neuropeptides with analgesics properties. They potentiate the effect of analgesics. No evidence indicates that noninvasive and nonpharmacologic measures are more effective than analgesics in relieving pain. Decreased input over large fibers allows more pain impulses to reach the central nervous system. There is no connection between type C fiber impulses and noninvasive and nonpharmacologic pain-control measures.
Question 67 |
Assessment plays an important role in nursing care. During the nursing assessment, which data represent information concerning health beliefs?
A | Family role and relationship patterns |
B | Educational level and financial status |
C | Promotive, preventive, and restorative health practices |
D | Use of prescribed and over-the-counter medications |
Question 67 Explanation:
ANSWER: Promotive, preventive, and restorative health practices ; RATIONALE: The health-beliefs assessment includes expectations of health care; promotive, preventive, and restorative practices, such as breast self-examination, testicular examination, and seat-belt use; and how the client perceives illness. Use of medications provides information about the client’s personal habits. Educational level, financial status, and family role and relationship patterns represent information associated with role and relationship patterns.
Question 68 |
The first action the nurse should take when caring for a client who is having fetal heart rates of 90–110 bpm during the contractions should be to:
A | Reposition the monitor |
B | Turn the client to her left side |
C | Ask the client to ambulate |
D | Prepare the client for delivery |
Question 68 Explanation:
ANSWER: Turn the client to her left side ; RATIONALE: The normal fetal heart rate is 120–160 bpm; 100–110bpm is bradycardia. The first action would be to turn the client to the left side and apply oxygen. Answer A is not indicated at this time. Answer C is not the best action for clients experiencing bradycardia. There is no data to indicate the need to move the client to the delivery room at this time.
Question 69 |
What would the nurse expect the admitting assessment to reveal in a 24 year old patient with Grave’s disease?
A | Bradycardia |
B | Decreased appetite |
C | Exophthalmos |
D | Weight gain |
Question 69 Explanation:
ANSWER: Exophthalmos ; RATIONALE: Exophthalmos (protrusion of eyeballs) often occurs with hyperthyroidism. The client with hyperthyroidism will often exhibit tachycardia, increased appetite, and weight loss; therefore, answers A, B, and D are incorrect.
Question 70 |
In planning for the day’s visits, which client should be seen first by the home health nurse?
A | The 78-year-old who had a gastrectomy 3 weeks ago and has a PEG tube |
B | The 5-month-old discharged 1 week ago with pneumonia who is being treated with amoxicillin liquid suspension |
C | The 50-year-old with MRSA being treated with Vancomycin via a PICC line |
D | The 30-year-old with an exacerbation of multiple sclerosis being treated with cortisone via a centrally placed venous catheter |
Question 70 Explanation:
ANSWER: The 30-year-old with an exacerbation of multiple sclerosis being treated with cortisone via a centrally placed venous catheter ; RATIONALE: The client at highest risk for complications is the client with multiple sclerosis who is being treated with cortisone via the central line. The others are more stable. MRSA is methicillin-resistant staphylococcus aureus. Vancomycin is the drug of choice and is given at scheduled times to maintain blood levels of the drug. The clients in answers A, B, and C are more stable and can be seen later.
Question 71 |
Lilia is assisting the staff nurse who is conducting assessment to a patient diagnosed with acute cholecystitis. Which clinical manifestation would the nurse expect the client to exhibit?
A | Jaundice, dark urine, and steatorrhea |
B | Acute right lower quadrant (RLQ) pain, diarrhea, and dehydration |
C | Ecchymosis petechiae, and coffee-ground emesis |
D | Nausea, vomiting, and anorexia |
Question 71 Explanation:
ANSWER: Nausea, vomiting, and anorexia ; RATIONALE: Acute cholecystitis is an acute inflammation of the gallbladder commonly manifested by the following: anorexia, nausea, and vomiting; biliary colic; tenderness and rigidity the right upper quadrant (RUQ) elicited on palpation (e.g., Murphy’s sign); fever; fat intolerance; and signs and symptoms of jaundice. Ecchymosis, petechiae, and coffee-ground emesis are clinical manifestations of esophageal bleeding. The coffee-ground appearance indicates old bleeding. Jaundice, dark urine, and steatorrhea are clinical manifestations of the icteric phase of hepatitis.
Question 72 |
Nurse Albie is caring for a patient with hepatic coma, which outcome would be the most appropriate?
A | The client is oriented to time, place, and person. |
B | The client exhibits no ecchymotic areas. |
C | The client increases oral intake to 2,000 calories/day. |
D | The client exhibits increased serum albumin level. |
Question 72 Explanation:
ANSWER: The client is oriented to time, place, and person. ; RATIONALE: Hepatic coma is the most advanced stage of hepatic encephalopathy. As hepatic coma resolves, improvement in the client’s level of consciousness occurs. The client should be able to express orientation to time, place, and person. Ecchymotic areas are related to decreased synthesis of clotting factors. Although oral intake may be related to level of consciousness, it is more closely related to anorexia. The serum albumin level reflects hepatic synthetic ability, not level of consciousness.
Question 73 |
Patient X is having electroconvulsive therapy for treatment of severe depression. Which of the following indicates that the client’s ECT has been effective?
A | The client loses consciousness. |
B | The client vomits. |
C | The client’s ECG indicates tachycardia. |
D | The client has a grand mal seizure. |
Question 73 Explanation:
ANSWER: The client has a grand mal seizure. ; RATIONALE: During ECT, the client will have a grand mal seize. This indicates completion of the electroconvulsive therapy. Answers A, B, and C do not indicate that the ECT has been effective, so are incorrect.
Question 74 |
Which term would the nurse Bea use to document pain at one site that is perceived in other site?
A | Referred pain |
B | Phantom pain |
C | Intractable pain |
D | Aftermath of pain |
Question 74 Explanation:
ANSWER: Referred pain ; RATIONALE: Referred pain is pain occurring at one site that is perceived in another site. Referred pain follows dermatome and nerve root patterns. Phantom pain refers to pain in a part of the body that is no longer there, such as in amputation. Intractable pain refers to moderate to severe pain that cannot be relieved by any known treatment. Aftermath of pain, a phase of the pain experience and the most neglected phase, addresses the client’s response to the pain experience.
Question 75 |
Which pain theory provides information most useful to nurses when planning pain reduction interventions?
A | Specificity theory |
B | Pattern theory |
C | Gate-control theory |
D | Central-control theory |
Question 75 Explanation:
ANSWER: Central-control theory ; RATIONALE: No one theory explains all the factors underlying the pain experience, but the central-control theory discusses brain opiates with analgesic properties and how their release can be affected by actions initiated by the client and caregivers. The gate-control, specificity, and patter theories do not address pain control to the depth included in the central-control theory.
Question 76 |
Nurse Gina is assigned at the nursery. She knows that nursing care of a newborn with narcotic abstinence syndrome should include:
A | Teaching the mother to provide tactile stimulation |
B | Wrapping the newborn snugly in a blanket |
C | Placing the newborn in the infant seat |
D | Initiating an early infant-stimulation program |
Question 76 Explanation:
ANSWER: Wrapping the newborn snugly in a blanket ; RATIONALE: The infant of an addicted mother will undergo withdrawal. Snugly wrapping the infant in a blanket will help prevent the muscle irritability that these babies often experience. Teaching the mother to provide tactile stimulation or provide for early infant stimulation are incorrect because he is irritable and needs quiet and little stimulation at this time, so answers A and D are incorrect. Placing the infant in an infant seat in answer C is incorrect because this will also cause movement that can increase muscle irritability.
Question 77 |
The teenager with a fiberglass cast asks the nurse if it will be okay to allow his friends to autograph his cast. Which response would be best?
A | “It will be alright for your friends to autograph the cast.” |
B | “Because the cast is made of plaster, autographing can weaken the cast.” |
C | “If they don’t use chalk to autograph, it is okay.” |
D | “Autographing or writing on the cast in any form will harm the cast.” |
Question 77 Explanation:
ANSWER: “It will be alright for your friends to autograph the cast.” ; RATIONALE: There is no reason that the client’s friends should not be allowed to autograph the cast; it will not harm the cast in any way, so answers B, C, and D are incorrect.
Question 78 |
A 6-year-old client has been admitted at the pediatric ward with a diagnosis of conjunctivitis. Before administering eye drops, the nurse should recognize that it is essential to consider which of the following?
A | The eye should be cleansed with warm water, removing any exudate, before instilling the eyedrops. |
B | The child should be allowed to instill his own eye drops. |
C | The mother should be allowed to instill the eyedrops. |
D | If the eye is clear from any redness or edema, the eyedrops should be held. |
Question 78 Explanation:
ANSWER: The eye should be cleansed with warm water, removing any exudate, before instilling the eyedrops. ; RATIONALE: Before instilling eye drops, the nurse should cleanse the area with water. A 6-year-old child is not developmentally ready to instill his own eyedrops, so answer B is incorrect. Although the mother of the child can instill the eyedrops, the area must be cleansed before administration, making answer C incorrect. Although the eye might appear to be clear, the nurse should instill the eyedrops, as ordered, so answer D is incorrect.
Question 79 |
Nurse Hero is handling a nurse who will be undergoing an arteriogram. During the procedure, the client tells the nurse, “I’m feeing really hot.” Which response would be best?
A | “You are having an allergic reaction. I will get an order for Benadryl.” |
B | “That feeling of warmth is normal when the dye is injected.” |
C | “That feeling of warmth indicates that the clots in the coronary vessels are dissolving.” |
D | “I will tell your doctor and let him explain to you the reason for the hot feeling that you are experiencing.” |
Question 79 Explanation:
ANSWER: “That feeling of warmth is normal when the dye is injected.” ; RATIONALE: It is normal for the client to have a warm sensation when dye is injected. Answers A, C, and D indicate that the nurse believes that the hot feeling is abnormal, so they are incorrect.
Question 80 |
Nurse Rob is caring for a client in the neonatal intensive care unit administers adult-strength Digitalis to the 3-pound infant. As a result of his actions, the baby suffers permanent heart and brain damage. The nurse can be charged with:
A | Negligence |
B | Tort |
C | Assault |
D | Malpractice |
Question 80 Explanation:
ANSWER: Malpractice ; RATIONALE: The nurse could be charged with malpractice, which is failing to perform, or performing an act that causes harm to the client. Giving the infant an overdose falls into this category. Answers A, B, and C are incorrect because they apply to other wrongful acts. Negligence is failing to perform care for the client; a tort is a wrongful act committed on the client or their belongings; and assault is a violent physical or verbal attack.
Question 81 |
A patient who has jaundice has been admitted under the care of Nurse Matt. Which statement indicates that the nurse understands the rationale for instituting skin care measures for the client?
A | “Jaundice is associated with pressure ulcer formation.” |
B | “Jaundice impairs urea production, which produces pruritus.” |
C | “Jaundice produces pruritus due to impaired bile acid excretion.” |
D | “Jaundice leads to decreased tissue perfusion and subsequent breakdown.” |
Question 81 Explanation:
ANSWER: “Jaundice produces pruritus due to impaired bile acid excretion.” ; RATIONALE: Jaundice is a symptom characterized by increased bilirubin concentration in the blood. Bile acid excretion is impaired, increasing the bile acids in the skin and causing pruritus. Jaundice is not associated with pressure ulcer formation. However, edema and hypoalbuminemia are. Jaundice itself does not impair urea production or lead to decreased tissue perfusion.
Question 82 |
The nurse is aware that the best way to prevent postoperative wound infection in the surgical client is to:
A | Administer a prescribed antibiotic |
B | Wash her hands for 2 minutes before care |
C | Wear a mask when providing care |
D | Ask the client to cover her mouth when she coughs |
Question 82 Explanation:
ANSWER: Wash her hands for 2 minutes before care ; RATIONALE: The best way to prevent post-operative wound infection is hand washing. Use of prescribed antibiotics will treat infection, not prevent infections, making answer A incorrect. Wearing a mask and asking the client to cover her mouth are good practices but will not prevent wound infections; therefore, answers C and D are incorrect.
Question 83 |
When communicating with a 4-year-old, which of the following statements is effective to be given by the nurse?
A | “Tell me where you hurt.” |
B | “Other children like having their blood pressure taken.” |
C | “This will be like having a little stick in your arm.” |
D | “Anything you tell me is confidential.” |
Question 83 Explanation:
ANSWER: “Tell me where you hurt.” ; RATIONALE: Four-year-olds are egocentric and interested in having the focus on themselves. They will not be interested in what it feels like to other children. Preschoolers are concrete thinkers and would literally interpret any analogies so they are not helpful in explaining procedures. Assurance of confidential communication is most appropriate for the adolescent. In addition, confidentiality is not maintained if the child plans to harm themselves, harm someone else, or discloses abuse.
Question 84 |
Which assignment should not be performed by the licensed practical nurse?
A | Inserting a Foley catheter |
B | Discontinuing a nasogastric tube |
C | Obtaining a sputum specimen |
D | Starting a blood transfusion |
Question 84 Explanation:
ANSWER: Starting a blood transfusion ; RATIONALE: The licensed practical nurse should not be assigned to begin a blood transfusion. The licensed practical nurse can insert a Foley catheter, discontinue a nasogastric tube, and collect sputum specimen; therefore, answers A, B, and C are incorrect.
Question 85 |
Which interventions should the nurse implement when addressing hepatic encephalopathy in a client who is in end-stage liver failure? (Select all that apply.)
A | Assessing the client’s neurologic status every 2 hours |
B | Monitoring the client’s hemoglobin and hematocrit levels |
C | Evaluating the client’s serum ammonia level |
D | Monitoring the client’s handwriting daily |
E | Preparing to insert an esophageal tamponade tube |
F | Making sure the client’s fingernails are short |
Question 85 Explanation:
ANSWER: Assessing the client’s neurologic status every 2 hours ; Evaluating the client’s serum ammonia level ; Monitoring the client’s handwriting daily; RATIONALE: Hepatic encephalopathy results from an increased ammonia level due to the liver’s inability to covert ammonia to urea, which leads to neurologic dysfunction and possible brain damage. The nurse should monitor the client’s neurologic status, serum ammonia level, and handwriting. Monitoring the client’s hemoglobin and hematocrit levels and insertion of an esophageal tamponade tube address esophageal bleeding. Keeping fingernails short address jaundice.
Question 86 |
The nurse should take which of the following actions when a vaginal exam reveals a footling breech presentation?
A | Anticipate the need for a Caesarean section |
B | Apply the fetal heart monitor |
C | Place the client in Genupectoral position |
D | Perform an ultrasound exam |
Question 86 Explanation:
ANSWER: Apply the fetal heart monitor ; RATIONALE: Applying a fetal heart monitor is the correct action at this time. There is no need to prepare for a Caesarean section or to place the client in Genupectoral position (knee-chest), so answers A and C are incorrect. Answer D is incorrect because there is no need for an ultrasound based on the finding.
Question 87 |
When caring for a client with advanced cirrhosis and who has been diagnosed with hepatic encephalopathy, the nurse expects to assess for:
A | Malaise |
B | Stomatitis |
C | Hand tremors |
D | Weight loss |
Question 87 Explanation:
ANSWER: Hand tremors ; RATIONALE: Hepatic encephalopathy results from the accumulation of neurotoxins in the blood, therefore the nurse wants to assess for signs of neurological involvement. Flapping of the hands (asterixis), changes in mentation, agitation, and confusion are common. These clients typically have ascites and edema so experience weight gain. Malaise and stomatitis are not related to neurological involvement.
Question 88 |
Mrs. Jordan’s 6-year old child received a small paper cut on his finger, let him wash it and applied a small amount of antibacterial ointment and bandage. Then she let him watch TV and eat an apple. This is an example of which type of pain intervention?
A | Pharmacologic therapy |
B | Environmental alteration |
C | Control and distraction |
D | Cutaneous stimulation |
Question 88 Explanation:
ANSWER: Control and distraction ; RATIONALE: The mothers actions are example of control and distraction. Involving the child in care and providing distraction took his mind off the pain. Pharmacologic agents for pain analgesics — were not used. The home environment was not changed, and cutaneous stimulation, such as massage, vibration, or pressure, was not used.
Question 89 |
Today, Nurse Aron is assigned to a 5-year-old client who is being tested for enterobiasis (pinworms). To collect a specimen for assessment of pinworms, the nurse should teach the mother to:
A | Examine the perianal area with a flashlight 2 or 3 hours after the child is asleep |
B | Scrape the skin with a piece of cardboard and bring it to the clinic |
C | Obtain a stool specimen in the afternoon |
D | Bring a hair sample to the clinic for evaluation |
Question 89 Explanation:
ANSWER: Examine the perianal area with a flashlight 2 or 3 hours after the child is asleep ; RATIONALE: Infection with pinworms begins when the eggs are ingested or inhaled. The eggs hatch in the upper intestine and mature in 2–8 weeks. The females then mate and migrate out the anus, where they lay up to 17,000 eggs. This causes intense itching. The mother should be told to use a flashlight to examine the rectal area about 2–3 hours after the child is asleep. Placing clear tape on a tongue blade will allow the eggs to adhere to the tape. The specimen should then be brought in to be evaluated. There is no need to scrape the skin, collect a stool specimen, or bring a sample of hair, so answers B, C, and D are incorrect.
Question 90 |
Which information should be reported to the state Board of Nursing?
A | The facility fails to provide literature in both Spanish and English. |
B | The narcotic count has been incorrect on the unit for the past 3 days. |
C | The client fails to receive an itemized account of his bills and services received during his hospital stay. |
D | The nursing assistant assigned to the client with hepatitis fails to feed the client and give the bath. |
Question 90 Explanation:
ANSWER: The narcotic count has been incorrect on the unit for the past 3 days. ; RATIONALE: The Joint Commission on Accreditation of Hospitals will probably be interested in the problems in answers A and C. The failure of the nursing assistant to care for the client with hepatitis might result in termination, but is not of interest to the Joint Commission.
Question 91 |
In the assessment of a client with a total knee replacement 2 hours post-operative, which information requires notification of the doctor?
A | Bleeding on the dressing is 3cm in diameter. |
B | The client has a temperature of 6°F. |
C | The client’s hematocrit is 26%. |
D | The urinary output has been 60 during the last 2 hours. |
Question 91 Explanation:
ANSWER: The client’s hematocrit is 26%. ; RATIONALE: The client with a total knee replacement should be assessed for anemia. A hematocrit of 26% is extremely low and might require a blood transfusion. Bleeding of 2cm on the dressing is not extreme. Circle and date and time the bleeding and monitor for changes in the client’s status. A low-grade temperature is not unusual after surgery. Ensure that the client is well hydrated, and recheck the temperature in 1 hour. If the temperature is above 101°F, report this finding to the doctor. Tylenol will probably be ordered. Voiding after surgery is also not uncommon and no need for concern; therefore answers A, B, and D are incorrect.
Question 92 |
Nikki is a fire survivor and has experienced severe burns 6 months ago. He is currently expressing concern about the possible loss of job-performance abilities and physical disfigurement. Which intervention is the most appropriate for him?
A | Referring the client for counseling and occupational therapy |
B | Staying with the client as much as possible and building trust |
C | Providing cutaneous stimulation and pharmacologic therapy |
D | Providing distraction and guided imagery techniques |
Question 92 Explanation:
ANSWER: Referring the client for counseling and occupational therapy ; RATIONALE: Because it has been 6 months, the client needs professional help to get on with life and handle the limitations imposed by the current problems. Staying with the client, building trust, and providing method of pain relief, such as cutaneous stimulation, medications, distraction, and guided imagery interventions, would have been more appropriate in earlier stages of postburn injury, when physical pain was most severe and fewer psychologic factors needed to be addressed.
Question 93 |
Which nursing action should be given priority for a client returns to the unit from surgery with a blood pressure of 90/50, pulse 132, and respirations 30?
A | Continuing to monitor the vital signs |
B | Contacting the physician |
C | Asking the client how he feels |
D | Asking the LPN to continue the post-op care |
Question 93 Explanation:
ANSWER: Contacting the physician ; RATIONALE: The vital signs are abnormal and should be reported immediately. Continuing to monitor the vital signs can result in deterioration of the client’s condition, making answer A incorrect. Asking the client how he feels in answer C will only provide subjective data, and the nurse in answer D is not the best nurse to assign because this client is unstable.
Question 94 |
Nurse Harold is caring for a client who is fitted for a behind-the-ear hearing aid. Which instruction should be given?
A | Remove the mold and clean every week. |
B | Store the hearing aid in a warm place. |
C | Clean the lint from the hearing aid with a toothpick. |
D | Change the batteries weekly. |
Question 94 Explanation:
ANSWER: Store the hearing aid in a warm place. ; RATIONALE: The hearing aid should be stored in a warm, dry place. It should be cleaned daily but should not be moldy, so answer A is incorrect. A toothpick is inappropriate to use to clean the aid; the toothpick might break off in the hearing aide, making answer C incorrect. Changing the batteries weekly, as in answer D, is not necessary.
Question 95 |
Which of the following assessment should the nurse look out for when assessing a newborn whose mother consumed alcohol during the pregnancy?
A | wide-spaced eyes, smooth philtrum, flattened nose |
B | strong tongue thrust, short palpebral fissures, simian crease |
C | negative Babinski sign, hyperreflexia, deafness |
D | shortened limbs, increased jitteriness, constant sucking |
Question 95 Explanation:
ANSWER: wide-spaced eyes, smooth philtrum, flattened nose ; RATIONALE: The nurse should anticipate that the infant may have fetal alcohol syndrome and should assess for signs and symptoms of it. These include the characteristics listed in choice A.
Question 96 |
Mr. Abbott, has recently undergone an open reduction and internal fixation of the left hip. One day after the operation, he complains of pain. Which data would cause the nurse to refrain from administering the pain medication and to notify the health care provider instead?
A | Left hip dressing dry and intact |
B | Blood pressure of 114/78 mm Hg; pulse rate of 82 beats per minute |
C | Left leg in functional anatomic position |
D | Left foot cold to touch; no palpable pedal pulse |
Question 96 Explanation:
ANSWER: Left foot cold to touch; no palpable pedal pulse ; RATIONALE: A left foot cold to touch without palpable pedal pulse represents an abnormal finding on neurovascular assessment of the left leg. The client is most likely experiencing some complication from surgery, which requires immediate medical intervention. The nurse should notify the health care provider of these findings. A dry and intact hip dressing, blood pressure of 114/78 mm Hg, pulse rate of 82 beats per minute, and a left foot in functional anatomic position are all normal assessment findings that do not require medical intervention.
Question 97 |
Which roommate would be most suitable for the 6-year-old male with a fractured femur in Russell’s traction?
A | 16-year-old female with scoliosis |
B | 12-year-old male with a fractured femur |
C | 10-year-old male with sarcoma |
D | 6-year-old male with osteomyelitis |
Question 97 Explanation:
ANSWER: 12-year-old male with a fractured femur ; RATIONALE: The 6-year-old should have a roommate as close to the same age as possible, so the 12-year-old is the best match. The 10-year-old with sarcoma has cancer and will be treated with chemotherapy that makes him immune suppressed, the 6-year-old with osteomyelitis is infected, and the client in answer A is too old and is female; therefore, answers A, C, and D are incorrect.
Question 98 |
The nurse knows that all of the following characteristics would indicate that an elder client might experience undesirable effects of medicines except:
A | increased oxidative enzyme levels. |
B | alcohol taken with medication. |
C | medications containing magnesium. |
D | decreased serum albumin. |
Question 98 Explanation:
ANSWER: increased oxidative enzyme levels. ; RATIONALE: Oxidative enzyme levels decrease in the elderly, which affects the disposition of medication and can alter the therapeutic effects of medication. Alcohol has a smaller water distribution level in the elderly, resulting in higher blood alcohol levels. Alcohol also interacts with various drugs to either potentate or interfere with their effects. Magnesium is contained in a lot of medications elder clients routinely obtain over the counter. Magnesium toxicity is a real concern. Albumin is the major drug-binding protein. Decreased levels of serum albumin mean that higher levels of the drug remain free and that there are less therapeutic effects and increased drug interactions.
Question 99 |
Regine is admitted and her vaginal exam reveals that she is 2cm dilated. Which of the following statements would the nurse expect her to make?
A | “We have a name picked out for the baby.” |
B | “I need to push when I have a contraction.” |
C | “I can’t concentrate if anyone is touching me.” |
D | “When can I get my epidural?” |
Question 99 Explanation:
ANSWER: “When can I get my epidural?” ; RATIONALE: Dilation of 2 cm marks the end of the latent phase of labor. Answer A is a vague answer, answer B indicates the end of the first stage of labor, and answer C indicates the transition phase.
Question 100 |
Which of the following nursing interventions are appropriate to prevent skin breakdown in a patient diagnosed with chronic cirrhosis, who has ascites and pitting peripheral edema and also has hepatic encephalopathy? (Select all that apply.)
A | Range of motion every 4 hours |
B | Turn and reposition every 2 hours |
C | Abdominal and foot massages every 2 hours |
D | Alternating air pressure mattress |
E | Sit in chair for 30 minutes each shift |
Question 100 Explanation:
ANSWER: Turn and reposition every 2 hours ; Alternating air pressure mattress ; RATIONALE: Edematous tissue must receive meticulous care to prevent tissue breakdown. Range of motion exercises preserve joint function but do not prevent skin breakdown. Abdominal or foot massage will not prevent skin breakdown but must be cleansed carefully to prevent breaks in skin integrity. The feet should be kept at the level of heart or higher so Fowler’s position should be employed. An air pressure mattress, careful repositioning can prevent skin breakdown.
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