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1. Lisa is newly diagnosed with asthma and is being discharged from the
hospital after an episode of status asthmaticus. Discharge teaching should
include which of the following:

A. Limitations in sports that will be imposed by the illness

B. SpeciMc instructions on staying cal during an attack
C. The relationship of symptoms and a speciMc trigger such as physical
exercise
D. Incidence of status asthmaticus in children and teens

2. Which of the following symptoms is most characteristic of a client with a

cancer of the lung?

A. air hunger
B. exertional dyspnea
C. cough with night sweats
D. persistent changing cough

3. The client has ST segment depression on his 12-lead ECG. The nurse
determines that this would indicate the following:

A. necrosis
B. injury
C. ischemia
D. nothing signiMcant

4. Red has just returned from the postanesthesia care unit (PACU) from a
hemorrhidectomy. His postoperative orders include sitz baths every morning.
The nurse understands that sitz bath is use for:

A. promote healing
B. relive tension
C. lower body temperature
D. cause swelling

5. Trousseau’s sign is associated with which electrolyte imbalance?

A. hyponatremia
B. hypocalcemia
C. hypernatremia
D. hypercalcemia

6. A 36 year old female complains of headache and neck pain. The nurse’s
assessments reveal painful bexion of the neck to the chest. The nurse
understands that nuchal rigidity is associated with:

A. brain tumor
B. CVA
C. meningitis
D. subdural hematoma

7. The nurse teaching the client about behavioral changes, which can affect
development of atherosclerosis, should discuss which of the following as a
non-modiMable risk factor for atherosclerosis?

A. cigarette smoking
B. hyperlipidemia
C. female over 55 years of age
D. sedentary lifestyle

8. A 76 year old man enters the ER with complaints of back pain and feeling
fatigued. Upon examination, his blood pressure is 190/100, pulse is 118, and
hematocrit and hemoglobin are both low. The nurse palpates the abdomen
which is soft, non-tender and auscultates an abdominal pulse. The most likely
diagnosis is:

A. Buerger’s disease
B. CHF
C. Secondary hypertension
D. Aneurysm

9. Nurse Fiona is caring a patient with Raynaud’s disease. Which of the

following outcomes concerning medication regimen is of highest priority?

A. Controlling the pain once vasospasm occur

B. Relaxing smooth muscle to avoid vasospasms
C. Preventing major disabilities that may occur
D. Avoiding lesions on the feet

10. Mr. Roberto Robles complains of a severe headache and is extremely

anxious. The nurse checks his vital signs and Mnds him to have a heart rate of
57 bpm and a blood pressure of 230/110 mmHg. The nurse should also
assess for?

A. presence of bowel sounds

B. presence of babinski rebex
C. fecal incontinence
D. urinary catheter patency

11. A 40n year old male patient is complaining of chronic progressive and
mental deterioration is admitted to the unit. The nurse recognizes that these
characteristics indicate a disease that results in degeneration of the basal
ganglia and cerebral cortex. The disease is called:

A. multiple sclerosis
B. myasthenia gravis
C. Huntington’s disease
D. Guillain-Barre syndrome

12. Dianne Hizon is a 27 year old woman who has been admitted to the ER
due to severe vomiting. Her ABG values are pH= 7.50, PaCO2= 85, HCO3= 31,
and SaO2= 93%. The nurse interpretation of this ABG analysis is:

A. respiratory acidosis
B. respiratory alkalosis
C. metabolic acidosis
D. metabolic alkalosis

13. Mr. Perkson has a parkinson’s disease and he Mnds the resting tremor he
is experiencing in his right hand very frustrating. The nurse advises him to:

A. take a warm bath

B. hold an object
C. practice deep breathing
D. take diazepam as needed

14. A shuming gait is typically associated with the patient who has:

A. Parkinson’s disease
B. Multiple sclerosis
C. Raynaud’s disease
D. Myasthenia gravis

15. The priority in preparing the room for a client with a C7 spinal cord injury
is having:

A. the halo brace device

B. a catheterization tray
C. a ventilator on stand by
D. the spinal kinetic bed

16. A 47 year old man with liver failure who has developed ascites. The nurse
understands that ascites is due to:

A. dehydration
B. protein deMciency
C. bleeding disorders
D. vitamin deMciency

17. A client with rheumatoid arthritis may reveal which of the following
assessment data:

A. Heberden’s nodes
B. Morning stiffness no longer than 30 minutes
C. Asymmetric joint swelling
D. Swan neck deformities

18. Elsa Santos is a 18 year old student admitted to the ward with a diagnosis
of epilepsy. She tells the nurse that she is experiencing a generalized tingling
sensation and is “smelling roses”. The nurse understands that Esla is
probably experiencing:

A. an acute alcohol withdrawal

B. an acute CVA
C. an aura
D. an olfactory hallucination

19. Mr. Lucas, a 63 year old, went to the clinic complaining of hoarseness of
voice and a cough. His wife states that his voice has changed in the last few
months. The nurse interprets that Mr. Lucas’s symptoms are consistent with
which of the following disorders:

A. chronic sinusitis
B. laryngeal cancer
C. gastroesophageal rebux disease
D. coronary artery disease

20. Sarah complains of a nursing sensation, cramping pain in the top part of
her abdomen that becomes worse in the afternoon and sometimes awakes
her at night. She reports that when she eats, it helps the pain go away but
that pain is now becoming more intense. Which of the following is the best
condition for the nurse to draw:

A. these symptoms are consistent with an ulcer

B. The client probably has indigestion
C. A snack before going to bed should be advised
D. The client probably developing cholelithiasis

21. Nurse Cynthia is providing a discharge teaching to a client with chronic

cirrhosis. His wife asks her to explain why there is so much emphasis on
bleeding precautions. Which of the following provides the most appropriate
response?

A. “The low protein diet will result in reduced clotting.”

B. “The increased production of bile decreases clotting factors.”
C. “The liver affected by cirrhosis is unable to produce clotting factors.”
D. “The required medications reduce clotting factors.”
22. Betty Lee is a 58 year old woman who is being admitted to the medical
ward with trigeminal neuralgia. The nurse anticipates that Mr. Lee will
demonstrate which of the following major complaints?

A. excruciating, intermittent, paroxysmal facial pain

B. unilateral facial droop
C. painless eye spasm
D. mildly painful unilateral eye twitching

23. A 38 year old woman returns from a subtotal thryroidectomy for the
treatment of hyperthyroidism. Upon assessment, the immediate priority that
the nurse would include is:

A. Assess for pain

B. Assess for neurological status
C. Assess buid volume status
D. Assess for respiratory distress

24. Nurse Shiela is teaching self-care to a client with psoriasis. The nurse
should encourage which of the following for his scaled lesion?

A. Importance of follow-up appointments

B. Emollients and moisturizers to soften scales
C. Keep occlusive dressings on the lesions 24 hours a day
D. Use of a clean razor blade each time he shaves

25. A 48 year old woman presents to the hospital complaining of chest pain,
tachycardia and dyspnea. On exam, heart sounds are mumed. Which of the
following assessment Mndings would support a diagnosis of cardiac
tamponade?

A. A deviated trachea
B. Absent breath sounds to the lower lobes
C. Pulse 40 with inspiration
D. Blood pressure 140/80

Answers and Rationales

1. C. The relationship of symptoms and a speci:c trigger such as physical

exercise. COPD clients have low oxygen and high carbon dioxide levels.
Therefore, hypoxia is the main stimulus for ventilation is persons with
chronic hypercapnea. Increasing the level of oxygen would decrease the
stimulus to breathe.
2. D. persistent changing cough. The most common sign of lung cancer is
a persistent cough that changes. Other signs are dyspnea, bloody
sputum and long term pulmonary infection. Option A is common with
asthma, option B is common with COPD and option C is common with
TB.
 3. C. ischemia. Depressed ST segment and inverted T-waves represent
myocardial ischemia. Injury has a ST segment elevation.
4. A. promote healing. Sitz bath provides moist heat to the perineal and
anal area to clean, promote healing and drainage and reduce soreness to
the area. Sitz bath helps healing with cleaning action and promotion of
circulation, thereby reducing swelling. Sitz bath usually has no
therapeutic value in lowering body temperature. Although relief of tension
can occur, this effect is secondary to the promotion of healing.
5. B. hypocalcemia. Trousseau’s sign is a carpal pedal spasm elicited when
a blood pressure cuff is inbated on the arm of a patient with
hypocalcemia.
6. C. meningitis. A patient with meningitis will exhibit signs that include
photophobia and nuchal rigidity, which is pain on the bexion of the chin to
chest.
7. C. female over 55 years of age. Lifestyle, cigarette smoking and
hyperlipidemia can be changed by changing behaviors.
8. D. Aneurysm. The symptoms exhibited by the client are typical of an
abdominal aortic aneurysm. The most signiMcant sign is the audible
pulse in the abdominal area. If hemorrhage were present, the abdomen
would be tender and Mrm.
9. B. Relaxing smooth muscle to avoid vasospasms. The major task of the
health care team is to medicate the client drugs that produce smooth
muscle relaxation, which will decrease the vasospasm and increase the
arterial bow to the affected part. The drugs used are calcium
antagonists.
10. D. urinary catheter patency. The patient is complaining of symptoms of
autonomic dysrebexia, which consists of the triad of hypertension,
bradycardia and a headache. Major causes of autonomic dysrebexia
include urinary bladder distention and fecal impaction. Checking the
patency of the urinary catheter will check for bladder distention.
11. C. Huntington’s disease. Huntington’s disease is a hereditary disease in
which degeneration of the basal ganglia and cerebral cortex causes
chronic progressive chorea (muscle twitching) and mental deterioration,
ending in dementia. Huntington’s disease usually strikes people ages 25
to 55.
12. D. metabolic alkalosis. Ms. Hizon’s pH is above 7.45, which makes it
alkalatic, and her bicarbonate is high which is also makes it basic. Thus,
the diagnosis is metabolic alkalosis.
13. B. hold an object. The resting or non-intentional tremor may be
controlled with purposeful movement such as holding an object. A warm
bath, deep breathing and diazepam will promote relaxation but are not
speciMc interventions for tremor.
14. A. Parkinson’s disease. A shuming gait from the musculoskeletal rigidity
of the patient with Parkinson’s disease is common. Patients experiencing
a stroke usually exhibit loss of voluntary control over motor movements
associated with generalized weakness; a shuming gait is usually not
observed in stroke patient.
15. C. a ventilator on stand by. Although a ventilator is not required for injury
 below C3, the innervation of intercostal muscles is affected. Hemorrhage
and cord swelling extends the level of injury making it likely that this
client will need a ventilator.
16. B. protein de:ciency. Protein deMciency allows buid to leak out of the
vascular system and third space into the tissues and spaces in the body
such as the peritoneal space. Bleeding tendencies, dehydration and
vitamin deMciency can occur but don’t cause ascites.
17. D. Swan neck deformities. Swan neck deformities of the hand are
classic deformities associated with rheumatoid arthritis secondary to the
presence of Mbrous connective tissue within the joint space. Clients with
RA do experience morning stiffness, but it can last from 30 minutes up to
several hours. RA is characterized by symmetrical joint movement, and
heberden’s nodes are characteristic of osteoarthritis.
18. C. an aura. An aura frequently precedes an epileptic seizure and may
manifest as vague physic discomfort or speciMc aromas. Patients
experiencing auras aren’t having a CVA, substance withdrawal or
hallucination.
19. B. laryngeal cancer. These symptoms, along with dysphagia, foul-
smelling breath, and pain when drinking hot or acidic, are common signs
of laryngeal cancer.
20. A. these symptoms are consistent with an ulcer. The description of pain
is consistent with ulcer pain. The pain is epigastric and is worse when
the stomach is empty and is relived by food.
21. C. “The liver affected by cirrhosis is unable to produce clotting
factors.” When bile production is reduced, the body has reduced ability to
absorb fat-soluble vitamins. Without adequate Vitamin K absorption,
clotting factors II, VII, IX, and X are not produced in suscient amounts.
22. A. excruciating, intermittent, paroxysmal facial pain. Trigeminal
neuralgia is a syndrome of excruciating, intermittent, paroxysmal facial
pain. It manifests as intense, periodic pain in the lips, gums, teeth or chin.
The other symptoms aren’t characteristic of trigeminal neuralgia.
23. D. Assess for respiratory distress. Though buid volume status,
neurological status and pain are all important assessment, the
immediate priority for postoperative is the airway management.
Respiratory distress may result from hemorrhage, edema, laryngeal
damage or tetany.
24. B. Emollients and moisturizers to soften scales. Emollients will ease dry
skin that increases pruritus and causes psoriasis to be worse. Washing
and drying the skin with rough linens or pressure may cause excoriation.
Constant occlusion may increase the effects of the medication and
increase the risk of infection.
25. C. Pulse 40 with inspiration. Paradoxical pulse is a hallmark symptom of
cardiac tamponade. As pressure is exerted on the left ventricle from buid,
the natural increase in pressure from the right ventricle during inspiration
creates even more pressure, diminishing cardiac output.
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