1. Which information is a priority for the RN to reinforce to an older client afterintravenous pylegraphy?
A) Eat a light diet for the rest of the day
B) Rest for the next 24 hours since the preparation and the test is tiring.
C) During waking hours drink at least 1 8-ounce glass of fluid every hour for the next 2days
D) Measure the urine output for the next day and immediately notify the health careprovider if it should decrease.
The correct answer is D: Measure the urine output for the next day and immediatelynotify the health care provider if it should decrease.
2. A client has altered renal function and is being treated at home. The nurse recognizesthat the most accurate indicator of fluid balance during the weekly visits is
A) difference in the intake and output
B) changes in the mucous membranes
C) skin turgor
D) weekly weight
The correct answer is D: weekly weight
3. A client has been diagnosed with Zollinger-Ellison syndrome.Which information ismost important for the nurse to reinforce with the client?
A) It is a condition in which one or more tumors called gastrinomas form in the pancreasor in the upper part of the small intestine (duodenum)
B) It is critical to report promptly to your health care provider any findings of pepticulcers
c)Treatment consists of medications to reduce acid and heal any peptic ulcers and, ifpossible, surgery to remove any tumors
D)With the average age at diagnosis at 50 years the peptic ulcers may occur at unusualareas of the stomach or intestine
The correct answer is B: It is critical to report promptly to your health care provider anyfindings of peptic ulcers .
4. A primigravida in the third trimester is hospitalized for preeclampsia. The nurse
determines that the client’s blood pressure is increasing. Which action should the nurse take first?
A) Check the protein level in urine
B) Have the client turn to the left side
C) Take the temperature
D) Monitor the urine output
The correct answer is B: Have the client turn to the left side
5. The nurse is caring for a client in atrial fibrillation. The atrial heart rate is 250 and theventricular rate is controlled at 75. Which of the following findings is cause for the most concern?
A) Diminished bowel sounds
B) Loss of appetite
C) A cold, pale lower leg
D) Tachypnea
The correct answer is C: A cold, pale lower leg
6. The client with infective endocarditis must be assessed frequently by the home healthnurse. Which finding suggests that antibiotic therapy is not effective, and must be reported by the nurse immediately to the healthcare provider?
A) Nausea and vomiting
B) Fever of 103 degrees Fahrenheit (39.5 degrees Celsius)
C) Diffuse macular rash
D) Muscle tenderness
The correct answer is B: Fever of 103 degrees F (39.5 degrees C)
7. A client who had a vasectomy is in the post recovery unit at an outpatient clinic. Whichof these points is most important to be reinforced by the nurse?
A) Until the health care provider has determined that your ejaculate doesn’t containsperm, continue to use another form of contraception.
B) This procedure doesn’t impede the production of male hormones or the production ofsperm in the testicles. The sperm can no longer enter your semen and no sperm are in your ejaculate.
C) After your vasectomy, strenuous activity needs to be avoided for at least 48 hours. If your work doesn’t involve hard physical labor, you can return to your job as soon as you
feel up to it. The stitches
generally dissolve in seven to ten days.
D) The health care provider at this clinic recommends rest, ice, an athletic supporter orover-the-counter pain medication to relieve any discomfort.
The correct answer is A: Until the health care provider has determined that your ejaculatedoesn’t contain sperm, continue to use another form of contraception.
8. A client who is to have antineoplastic chemotherapy tells the nurses of a fear of being sick all the time and wishes to try acupuncture. Which of these beliefs stated by the clientwould be incorrect about acupuncture?
A) Some needles go as deep as 3 inches, depending on where they’re placed in the bodyand what the treatment is for. The needles usually are left in for 15 to 30 minutes.
B) In traditional Chinese medicine, imbalances in the basic energetic flow of life —known as qi or chi —
are thought to cause illness.
* C) The flow of life is believed to flow through major pathways or nerve clusters in yourbody.
D) By inserting extremely fine needles into some of the over 400 acupuncture points invarious combinations it is believed that energy flow will rebalance to allow the body’s natural healing
mechanisms to take over.
The correct answer is C: The flow of life is believed to flow through major pathways ornerve clusters in your body.
9. The nurse is discussing with a group of students the disease Kawasaki. What statementmade by a student about Kawasaki disease is incorrect?
A) It also called mucocutaneous lymph node syndrome because it affects the mucousmembranes (inside the mouth, throat and nose), skin and lymph nodes.
B) In the second phase of the disease, findings include peeling of the skin on the handsand feet with joint and abdominal pain
C) Kawasaki disease occurs most often in boys, children younger than age 5 and childrenof Hispanic descent
D) Initially findings are a sudden high fever, usually above 104 degrees Fahrenheit, whichlasts 1 to2 weeks The correct answer is C: Kawasaki disease occurs most often in boys, children younger
than age 5 and children of Hispanic descent
10. A client has viral pneumonia affecting 2/3 of the right lung. What would be the best position to teach the client to lie in every other hour during first 12 hours after admission?A) Side-lying on the left with the head elevated 10 degrees
B) Side-lying on the left with the head elevated 35 degrees
C) Side-lying on the right wil the head elevated 10 degrees
D) Side-lying on the right with the head elevated 35 degrees
The correct answer is A: Side-lying on the left with the head elevated 10 degrees
11. A client has an indwelling catheter with continuous bladder irrigation after undergoing a transurethral resection of the prostate (TURP) 12 hours ago. Which findingat this time should be reported to the health care provider?
A) Light, pink urine
B) occasional suprapubic cramping
C) minimal drainage into the urinary collection bag
D) complaints of the feeling of pulling on the urinary catheter The correct answer is C:minimal drainage into the urinary collection bag
12. A nurse is performing CPR on an adult who went into cardiopulmonary arrest. Another nurse enters the room in response to the call. After checking the client’s pulseand respirations, what should
be the function of the second nurse?
A) Relieve the nurse performing CPR
B) Go get the code cart
C) Participate with the compressions or breathing
D) Validate the client’s advanced directive
The correct answer is C: Participate with the compressions or breathing
13. The nurse assesses a 72 year-old client who was admitted for right sided congestiveheart failure. Which of the following would the nurse anticipate finding?
A) Decreased urinary outputB) Jugular vein distention
C) Pleural effusion
D) Bibasilar crackles
The correct answer is B: Jugular vein distention
14. A client with heart failure has a prescription for digoxin. The nurse is aware that sufficient potassium should be included in the diet because hypokalemia in combinationwith this medication
A) Can predispose to dysrhythmias
B) May lead to oliguria
C) May cause irritability and anxiety
D) Sometimes alters consciousness
The correct answer is A: Can predispose to dysrhythmias
15. A nurse assesses a young adult in the emergency room following a motor vehicleaccident. Which of the following neurological signs is of most concern?
A) Flaccid paralysis
B) Pupils fixed and dilated
C) Diminished spinal reflexes
D) Reduced sensory responses
The correct answer is B: Pupils fixed and dilated
16. A 14 year-old with a history of sickle cell disease is admitted to the hospital with adiagnosis of vaso- occlusive crisis. Which statements by the client would be most indicative of the etiology of this crisis?
A) ”I knew this would happen. I’ve been eating too much red meat lately.”
B) ”I really enjoyed my fishing trip yesterday. I caught 2 fish.”
C) ”I have really been working hard practicing with the debate team at school.” D)”I went to the health care provider last week for a cold and I have gotten worse.” The correct answer is D: “I went to the doctor last week for a cold and I have gottenworse.”
17. Which these findings would the nurse more closely associate with anemia in a 10month-old infant?
A) Hemoglobin level of 12 g/dI
B) Pale mucosa of the eyelids and lips
C) Hypoactivity
D) A heart rate between 140 to 160
The correct answer is B: Pale mucosa of the eyelids and lips
18. The nurse is caring for a client in hypertensive crisis in an intensive care unit. The
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