Neurological System
Knowing
1. The client with a spinal cord injury is prone to
experiencing autonomic dysreflexia. The nurse would
avoid which of the following measures to minimize the
risk of recurrence?
1. Strict adherence to a bowel retraining program
2. Keeping the linen wrinkle-free under the client
3. Preventing unnecessary pressure on the lower limbs
4. Limiting bladder catheterization to once every 12
hours
2. The nurse is caring for the client who begins to
experience seizure activity while in bed. Which of the
following actions by the nurse would be
contraindicated?
1. Loosening restrictive clothing
2. Restraining the client’s limbs
3. Removing the pillow and raising padded side rails
4. Positioning the client to the side, if possible, with the
head flexed forward
3. The nurse has instructed the family of a client with
brain attack (stroke) who has homonymous
hemianopsia about measures to help the client
overcome the deficit. The nurse determines that the
family understands the measures to use if they state
that they will:
1. Place objects in the client’s impaired field of vision.
2. Discourage the client from wearing eyeglasses.
3. Approach the client from the impaired field of vision.
4. Remind the client to turn the head to scan the lost
visual field.
4. The nurse is teaching the client with myasthenia
gravis about the prevention of myasthenic and
cholinergic crises The nurse tells the client that this is
most effectively done by:
1. Eating large, well balanced meal
2. Doing muscle-strengthening exercises
3. Doing ail chores early bi the day while less fatigued
4. Taking medications on time to maintain therapeutic
blood levels
5. The nurse has given suggestions to the client with
trigeminal neuralgia about strategies to minimize
episodes of pain. The nurse determines that the client
needs reinforcement of information if the client makes
which of the following statements?
1, “I will wash my face with cotton pads.
2, “I’ll have to start chewing on my unaffected side.
3. “1’ll try to eat my food either very warm or very
cold.’
4. “I should rinse my mouth if toothbrushing is painful.
6. The client is admitted to the hospital with a diagnosis
of Guillain-Barré syndrome. The nurse inquires during
the nursing admission interview if the client has a
history of:
1. Seizures or trauma to the brain
2. Meningitis during the last 5 years
3, Back injury or trauma to the spinal cord
4. Respiratory or gastrointestinal infection during the
previous month
7. The nurse is admitting a client with Guillain-Barré
syndrome to the nursing unit. The client has an
ascending paralysis to the level of the waist.
the complications of the disorder, the nurse brings
which of the following essential items into the clients
room?
1, Nebulizer and pulse oximeter
2, Blood pressure cuff and flashlight
3. Flashlight and incentive spirometer
4. Electrocardiographic monitoring electrodes and
intubation tray
8. The nurse is planning to institute seizure precautions
for a client who is being admitted from the emergency
department. Which of the following measures would
the nurse include in planning for the clients safety?
Select all that apply.
1. Padding the side rails of the bed
2. Placing an airway at the bedside
3. Placing the bed in the high position
4, Placing oxygen and suction equipment at the
bedside
5. Putting a padded tongue blade at the head of the bed
6. Having intravenous equipment ready for insertion of
an intravenous catheter
9. An unconscious client with multiple injuries arrives in
the emergency room. Which nursing intervention
receives the highest priority?
1. Establishing an airway.
2. Replacing blood loss.
3. Stopping bleeding from open wounds.
4. Checking for a neck fracture.
10. A client is at risk for increased intracranial pressure
(ICP). Which of the following would be the priority for
the nurse to monitor?
1. Unequal pupil size.
2. Decreasing systolic blood pressure.
3. Tachycardia.
4. Decreasing body temperature.
11. A client has signs of increased ICP. Which of the
following is an early indicator of deterioration in the
client's condition?
1. Widening pulse pressure.
2. Decrease in the pulse rate.
3. Dilated, fixed pupil.
4. Decrease in level of consciousness.
12. The client has a sustained ICP of 20 mm Hg.
Which client position would be most appropriate?
1. The head of the bed elevated 30 to 45 degrees.
2. Trendelenburg's position.
3. Left Sim's position.
4. The head elevated on two pillows.
13. The nurse administers mannitol (Osmitrol) to the
client with increased ICP. Which parameter requires
close monitoring?
1. Muscle relaxation.
2. Intake and output.
3. Widening of the pulse pressure.
4. Pupil dilation.
14. Which activity would the nurse encourage the client
to avoid when there is a risk for increased ICP?
1. Deep breathing.
2. Turning.
3. Coughing.
4. Passive range-of-motion exercises.
15. Which of the following describes decerebrate pos-
turing?
1. Internal rotation and adduction of arms with
flexion of elbows, wrists, and fingers.
2. Back hunched over, rigid flexion of all four ex-
tremities with supination of arms and plantar flexion
of feet.
3. Supination of arms, dorsiflexion of the feet.
4. Back arched, rigid extension of all four, extremities.
16. In planning the care for a client who has had a
posterior fossa (infratentorial) craniotomy, which of
the following is contraindicated when positioning the
client?
1. Keeping the client flat on one side or the other.
2. Elevating the head of the bed to 30 degrees.
3. Log rolling or turning as a unit when turning.
4. Keeping the neck in a neutral position.
17. Which of the following is contraindicated for a
client with seizure precautions?
1. Encouraging him to perform his own personal
hygiene.
2. Allowing him to wear his own clothing.
3. Assessing oral temperature with a glass ther-
mometer.
4. Encouraging him to be out of bed.
18. For breakfast on the morning a client is to have an
electroencephalogram (EEG), the client is served a soft-
boiled egg, toast with butter and marmalade, orange
juice, and coffee. Which of the following would the
nurse do?
1. Remove all the food.
2. Remove the coffee.
3. Remove the toast, butter, and marmalade only.
4. Substitute vegetable juice for the orange juice.
19. Which clinical manifestation does the nurse assess
as a typical reaction to long-term phenytoin
sodium (Dilantin) therapy?
1. Weight gain.
2. Insomnia.
3. Excessive growth of gum tissue.
4. Deteriorating eyesight.
20. During the first 24 hours after thrombolytic treat-
ment for an ischemic CVA, the primary goal is to
control the client's
1. pulse.
2. respirations.
3. blood pressure.
4. temperature.
21. What is a priority nursing assessment in the first
24 hours after admission of the client with a thrombotic
CVA?
1. Cholesterol level.
2. Pupil size and pupillary response.
3. Bowel sounds.
4. Echocardiogram.
22. Which food-related behaviors would the nurse
observe in a client who has had a CVA that has left
him with homonymous hemianopia?
1. Increased preference for foods high in salt.
2. Eating food on only half of the plate.
3. Forgetting the names of foods.
4. Inability to swallow liquids.
23. What is the expected outcome of thrombolytic drug
therapy for CVA?
1. Increased vascular permeability.
2. Vasoconstriction.
3. Dissolved emboli.
4. Prevention of hemorrhage.
24. A nurse is performing an assessment on a client who
is unconscious after sustaining a head injury. The nurse
should avoid performing the oculocephalic response
(dolls-eyes maneuver) if which condition is present in
the client?
1. A cervical cord injury
2. Lumbar trauma
3. Dilated pupils
4. Altered level of consciousness
25. A nurse develops a plan of care for a client with a
brain aneurysm who will be placed on aneurysm
precautions. Which of the following should be included
in the plan?
Select all that apply
1. Allow the client to drink one cup of caffeinated coffee
a day.
2. Allow the client to ambulate four times a day with
assistance.
3. Place a blood pressure cuff at the client’s bedside.
4. Close the shades in the client’s room during the day.
5. Leave the lights on in the client’s room at night.
26. A nurse is developing a plan of care for a client with
dysphagia following a brain attack (stroke). Which of the
following should the nurse include in the plan? Select all
that apply.
1. Thicken liquids.
2. Provide ample time for the client to chew and
swallow.
3. Assess for the presence of a swallow reflex.
4, Place the food on the affected side of the mouth.
5. Assist the client with eating.
27. A nurse is caring for a client after a craniotomy and
monitors the client for signs of increased intracranial
pressure (ICP). Which of the following, if noted in the
client, would indicate an early sign of increased ICP?
1. Confusion
2. Bradycardia
3. Widening of pulse pressure
4. Hyperthermia
28. An emergency department nurse is caring for a
client with a suspected diagnosis of meningitis. The
nurse will prepare the client for which of the following
tests to confirm the diagnosis?
1. CT Scan
2. Lumbar Puncture
3. Blood Culture
4. White Blood Cell count
29. A thymectomy accomplished via a median
sternotomy approach is performed in a client with a
diagnosis of myasthenia gravis. The nurse has developed
a postoperative plan of care for the client that includes
which of the following?
1. Avoid administering pain medication Lo prevent
respiratory depression.
2. Monitor the chest tube drainage.
3. Maintain intravenous infusion of lactated Ringer’s
solution.
4. Restrict visitors for 24 hours postoperatively.
30. A home care nurse is visiting a client with a diagnosis
of Parkinson’s disease. The client is taking benztropine
mesylate (Cogentin) orally daily. The nurse provides
information to the spouse regarding the side effects of
this medication and tells the spouse to report which side
effect if it occurs?
1. Inability to urinate
2. Decreased appetite
3. Shuffling gait
4. Irregular bowel movements
31. A client arrives in the hospital emergency
department with a closed head injury to the right side of
the head caused by an assault with a baseball bat. The
nurse assesses the client neurologically. Looking
primarily for motor response deficits that involve:
1. The left side of the body
2. The right side of the body
3. Both sides of the body equally
4. Cranial nerves only, such as speech and pupillary
response
32. A nurse is caring for a client who is on bed rest as
part of aneurysm precautions. The nurse would avoid
doing which of the following when giving respiratory
care to this client to prevent atelectasis?
1. Reposition gently side to side every 2 hours.
2. Assist with incentive spirometer.
3. Encourage hourly coughing.
4. Encourage hourly deep breathing.
33. A nurse is assisting with caloric testing of the
oculovestibular reflex in an unconscious client. Cold
water is injected into the left auditory canal. The client
exhibits eye conjugate movements toward the left,
followed by eye movement back to midline. The nurse
understands that this indicates the client has:
1. Brain death
2. A cerebral lesion
3. A temporal lesion
4. An intact brainstem
34. A nurse is assessing a client’s extraocular eye
movements as part of the neurologic examination. The
nurse is assessing which cranial nerves? Select all that
apply.
1. Cranial nerve II
2. Cranial nerve III
3. Cranial nerve IV
4. Cranial nerve V
5. Cranial nerve VI
6. Cranial nerve VIII
35. A nurse is assessing a client diagnosed with multiple
sclerosis (MS). Which symptom does the nurse expect to
find?
1. Vision changes
2. Absent deep tendon reflexes
3. Tremors at rest
4. Flaccid muscles
36. A client has a cerebral aneurysm. The physician
orders hydralazine (Apresoline), 15 mg I.V., every 4
hours as needed to keep the systolic
blood pressure under 140 mm Hg. The label on the
hydralazine vial reads “hydralazine 20 mg/ml.” To
administer the correct dose, how many milliliters of
medication should the nurse draw up in the syringe?
Record your answer using two decimal places.
Answer 0.75ml
37. A client is admitted to the hospital after sustaining a
closed head injury in a skiing accident. The physician
ordered neurologic assessments to be performed every
2 hours. The client’s neurologic assessments have been
unchanged since admission, and the client is
complaining of a headache. Which intervention by the
nurse is best?
1. Administer codeine 30 mg by mouth as ordered and
continue neurologic assessments as ordered.
2. Assess the client’s neurologic status for subtle
changes, administer acetaminophen, and then reassess
the client in 30 minutes.
3. Reassure the client that a headache is expected and
will go away without treatment.
4. Notify the physician; a headache is an early sign of
worsening neurologic status.
38. A registered nurse (RN) and licensed practical nurse
(LPN) are administering medications on the neurologic
floor. The LPN prepares to
administer phenytoin (Dilantin) to a client with a history
of seizures. As the LPN walks into the room, she hands
the medication to a nursing assistant. The LPN asks the
nursing assistant to give the client the medication after
completing the client’s morning care. What should the
registered nurse do?
1. Remind the LPN that she must administer the
medications herself.
2. Do nothing because the client has been taking the
medication for a long time.
3. Allow the nursing assistant to administer this dose
and tell the LPN later that it’s her responsibility to
administer the medication.
4. Take the medication from the nursing assistant and
administer it.
39. A nurse caring for a group of clients on the
neurological floor is working with a nursing assistant and
a licensed practical nurse (LPN). Their
client care assignment consists of a client with new-
onset seizure activity, a client with Alzheimer’s disease,
and a client who experienced a stroke. While
administering medications, the registered nurse
receives a call from the intensive care unit (ICU), saying
a client who underwent a craniotomy 24 hours ago must
be transferred to make room for a new admission. The
ancillary staff is providing morning care and assisting
clients with breakfast. How should the nurse direct the
staff to facilitate a timely transfer?
1. Tell the ICU they have to wait to transfer the client
because everyone is too busy to accept the client.
2. Ask the nursing assistant to finish providing care to
the clients and the LPN to administer the remaining
medications so the registered nurse can accept the
client from the ICU.
3. Administer the medications quickly and ask the
nursing assistant and LPN to finish providing care for the
clients.
4. Notify the supervisor that the client care assignment
is unsafe with the addition of the new client, and insist
she assist with the assignment.
40. During morning care, a nurse notes that a client
who’s had a spinal cord injury has experienced a change
in level of consciousness and isn’t answering questions
appropriately. The nurse checks the client’s vital signs
and measures his blood pressure at 180/110 mm Hg and
his heart rate at 125 beats/minute. She determines that
the client may be experiencing dysreflexia. What other
assessments should the nurse make? Select all that
apply.
1. Most recent bowel movement
2. Urine output
3. Percentage of meals taken
4. Medications ordered for hypertension
5. Pain level
41. After striking his head on a tree while falling from a
ladder, a client is admitted to the emergency
department. He’s unconscious and his
pupils are nonreactive. Which intervention should the
nurse question?
1. Giving him a barbiturate
2. Placing him on mechanical ventilation
3. Performing a lumbar puncture
4. Elevating the head of his bed
42. A nurse is teaching a client who was recently
diagnosed with myasthenia gravis. Which statement
should the nurse include in her teaching?
1. “You’ll continue to experience progressive muscle
weakness and sensory deficits.”
2. “You’ll need to take edrophonium (Tensilon) to treat
the disease.”
3. “The disease is a disorder of motor and sensory
dysfunction.”
4. “This disease doesn’t cause sensory impairment.”
43. A client with respiratory complications of multiple
sclerosis (MS) is admitted to the medical-surgical unit.
Which equipment is most important for the nurse to
keep at the client’s bedside?
1. Sphygmomanometer
2. Padded tongue blade
3. Nasal cannula and oxygen
4. Suction machine with catheters
44. For a client who has had a stroke, which intervention
can help prevent contracture in the lower legs?
1. Putting slippers on the client’s feet
2. Crossing the client’s ankles every 2 hours
3. Placing hand rolls on the balls of each foot
4. Attaching braces or splints to each foot and leg
RATIONALE: Attaching braces or splints to each foot and
leg prevents footdrop (a lower leg contracture) by
supporting the feet in proper alignment. Putting slippers
on the client’s feet can’t prevent footdrop because
slippers are too soft to support the ankle joints. Crossing
the ankles every 2 hours is contraindicated because it
can cause excess pressure and damage veins, promoting
thrombus formation.
Placing hand rolls on the balls of each foot doesn’t
prevent contractures because hand rolls are too soft to
support and hold the feet in
proper alignment.
45. A nurse received a shift report on four clients. Which
should she assess first?
1. An older adult returning to the unit after having a
carotid endarterectomy
2. An older adult admitted 3 hours earlier for
observation because of possible transient ischemic
attack
3. A middle-age adult who had a rhizotomy 2 days
earlier
4. A young adult admitted for observation and
management of migraine headaches
46. Three hours after injuring the spinal cord at the C6
level, a client receives high doses of methylprednisolone
sodium succinate (Solu-Medrol) to suppress breakdown
of the neurologic tissue membrane at the injury site. To
help prevent adverse effects of this drug, the nurse
expects the physician to order:
1. naloxone (Narcan).
2. famotidine (Pepcid).
3. nitroglycerin (N,tro-8id).
4. atracurium (Tracrium).
47. Friends come to visit a client admitted with new-
onset ischemic stroke. The stroke has caused aphasia
and right-sided weakness. The client
has an advance directive and an identified health care
power of attorney. The friends ask the nurse about the
client’s condition. How should the nurse respond?
1. “I’m not at liberty to discuss his condition with you.
You’ll have to speak to his power of attorney if you’d
like information.”
2. “I can’t tell you anything about his condition.”
3. “You’ll have to ask him how he is feeling.”
4. “He is unable to communicate as a result of a stroke,
so I’ll tell you what I think he’d want you to know.”
48. A client was seen and treated in the hospital
emergency department for treatment of a concussion.
The nurse
determines that the family needs reinforcement of the
discharge instructions if they verbalize to call the
physician for which client sign or symptom?
1 Difficulty speaking
2. Difficulty awakening
3. Vomiting
4. Minor headache
49. A client with myasthenia gravis arrives at the
hospital emergency department in suspected crisis. The
physician plans to administer edrophonium (Tensilon) to
differentiate between myasthenic and cholinergic crises.
The nurse prepares to administer which medication as
prescribed if the client is in cholinergic crisis?
1. Atropine sulfate
2. Morphine sulfate
3. Pyridostigmine bromide (Mestinon)
4. Protamine sulfate
50. A nurse is preparing to care for a client who had a
supratentorial craniotomy. The nurse plans to place the
client in which position?
1. Prone
2. Supine
3. Side lying
4. Semi fowlers
Special Senses
1. After an eye examination, a client is diagnosed with
open-angle glaucoma. The physician orders pilocarpine
ophthalmic solution (Pilocar), 0.25% gtt i, OU q.i.d.
Based on this prescription, the nurse should teach the
client or a family member to administer the drug by:
1. instilling one drop of pdocarpine 0.25% into both eyes
daily.
2. instilling one drop of pilocarpine 0.25% into both
eyes four times daily.
3. instilling one drop of pdocarpine 0.25% into the right
eye daily.
4. instilling one drop of pdocarpine 0.25% into the left
eye four times daily.
2. A client has just been diagnosed with early glaucoma.
During a teaching session, the nurse should:
1. provide instructions on eye patching.
2. assess the client’s visual acuity.
1. provide instructions on eye patching.
2. assess the client’s visual acuity.
3. demonstrate eye drop instillation.
4. teach about intraocular lens cleaning.
3. The nurse is performing an admission assessment on
a client with a diagnosis of detached retina. Which of
the following is associated with this eye disorder?
1. Total loss of vision
2. Pain in the affected eye
3. A yellow discoloration of the sclera
4. A sense of a curtain falling across the field of vision
4. A woman was working in her garden. She accidentally
sprayed insecticide into her right eye. She calls the
emergency department frantic and screaming for help.
The nurse should instruct the woman to take which
immediate action?
1. Call the physician.
2. Irrigate the eyes with water.
3. Come to the emergency room.
4. Irrigate the eyes with diluted hydrogen peroxide.
5. The nurse is preparing a teaching plan for a client who
is undergoing cataract extraction with intraocular
implantation. Which home care measures will the nurse
include in the plan? Select all that apply.
1. Avoid activities that require bending over.
2. Contact the surgeon if eye scratchiness occurs.
3. Place an eye shield on the surgical eye at bedtime.
4. Episodes of sudden severe pain in the eye are
expected.
5. Contact the surgeon if a decrease in visual acuity
occurs,
6. Take acetaminophen (Tylenol) for minor eye
discomfort.
6. Betaxolol hydrochloride (Betoptic) eye drops have
been prescribed for the client with glaucoma. Which of
the
following nursing actions is most appropriate related to
monitoring for the side effects of this medication?
1. Monitoring temperature
2. Monitoring blood pressure
3, Assessing peripheral pulses
4. Assessing blood glucose level
7. In preparation for cataract surgery. the nurse is to
administer cyclopentolate (Cyclogyl) eye drops. The
nurse administers the eye drops, knowing that the
purpose of this medication is to:
1. Produce miosis of the operative eye.
2. Dilate the pupil of the operative eye.
3. Provide lubrication to the operative eye.
4. Constrict the pupil of the operative eye.
8. A client asks, "What does the lens of my eye do?" The
nurse should explain that the lens of the eye
1. produces aqueous humor.
2. holds the rods and cones.
3. focuses light rays onto the retina.
4. regulates the amount of light entering the eye.
9. A client is admitted to outpatient surgery for a
cataract extraction on the right eye. The client asks the
nurse, "What causes cataracts in old people?" Which of
the following statements should form the
basis for the nurse's response? Cataracts most
commonly
1. are a result of chronic systemic disease.
2. are a result of the aging process.
3. are a result of injuries sustained early in life.
4. are a result of the prolonged use of drugs.
10. A client with a cataract would most likely complain
of which symptoms?
1. Halos and rainbows around lights.
2. Eye pain and irritation that worsens at night.
3. Blurred and hazy vision.
4. Eye strain and headache when doing close work.
11. A client is admitted through the emergency de-
partment with a diagnosis of detached retina in the
right eye. As the nurse completes the admission history,
the client reports that before the physician
patched his eye, he saw many spots, or "floaters." The
nurse should explain to the client that these
spots were caused by:
1. pieces of the retina floating in the eye.
2. blood cells released into the eye by the detachment.
3. contamination of the aqueous humor.
4. spasms of the retinal blood vessels traumatized by
the detachment.
12. Scleral buckling, a procedure used to treat retinal
detachment, involves
1. removing the torn segment of the retina and stitching
down the remaining segment.
2. replacing the torn segment of the retina with a strip
of retina from a donor.
3. stitching the retina firmly to the optic nerve to give it
support.
4. creating a splint to hold the retina together until a
scar can form and seal off the tear.
13. The client who has been treated for chronic open-
angle glaucoma (COAG) for 5 years asks the clinic nurse,
"How does glaucoma damage my eyesight?" The nurse's
reply should be based on the knowledge that COAG
1. results from chronic eye inflammation.
2. causes increased intraocular pressure.
3. leads to detachment of the retina.
4. is caused by decreased blood flow to the retina.
14. Which of the following signs or symptoms is most
commonly experienced by clients with COAG?
1. Eye pain.
2. Excessive lacrimation.
3. Colored light flashes.
4. Decreasing peripheral vision.
15. Miotics are frequently used in the treatment of
glaucoma. The nurse should understand that miotics
work by
1. paralyzing ciliary muscles.
2. constricting intraocular vessels.
3. constricting the pupil.
4. relaxing ciliary muscles.
16. The client with glaucoma is scheduled for a minor
surgical procedure. Which of the following orders
would require clarification or correction before the
nurse carries it out?
1. Administer morphine sulfate.
2. Administer atropine sulfate.
3. Teach deep breathing exercises.
4. Teach leg exercises.
17. Which of the following clinical manifestations
would the nurse associate with acute angle-closure
glaucoma?
1. Gradual loss of central vision.
2. Acute light sensitivity.
3. Loss of color vision.
4. Sudden eye pain.
18. The best method to remove cerumen from a
client's ear involves
1. inserting a cotton-tipped applicator into the external
canal.
2. irrigating the ear gently.
3. using aural suction.
4. using a cerumen curette.
19. A 50-year-old man has been taking aspirin regularly
for 6 months to prevent a heart attack. He informs the
nurse that he has noticed a constant "ringing" in both
ears. How should the nurse respond to the client's
comment?
1. Tell the client that tinnitus is associated with the
aging process.
2. Inform the client he needs a Weber test done.
3. Schedule the client for audiometric testing.
4. Inform the client that the "ringing" may be related
to the aspirin he has been taking for his heart.
20. The classic triad of symptoms associated with
Meniere's disease is vertigo, tinnitus, and
1. headache.
2. otitis media.
3. fluctuating hearing loss.
4. vomiting.
Answer: 3. Meniere's disease involves the inner ear and
is characterized by episodes of acute vertigo, tinnitus,
and fluctuating, progressive hearing loss. The severe
vertigo can lead to nausea and vomiting, but vomiting is
not considered one of the classic triad of symptoms.
Headache is not associated with Meniere's disease. Oti-
tis media is an inflammation of the middle ear.
21. The client with Meniere's disease is instructed to
modify his diet. The nurse would explain that the most
frequently recommended diet modification for
Meniere's disease is
1. low sodium.
2. high protein.
3. low carbohydrate.
4. low fat.
22. Which of the following statements by the client
would indicate that she understands the expected
course of Meniere's disease?
1. "The disease process will gradually extend to the
eyes."
2. "Control of the episodes is usually possible, but a
cure is not yet available."
3. "Continued medication therapy will cure the disease."
4. "Bilateral deafness is an inevitable outcome of the
disease."
23. The nurse would anticipate that all of the following
drugs may be used in the attempt to control the
symptoms of Meniere's disease excep?
1. antihistamines.
2. antiemetics.
3. diuretics.
4. glucocorticoids.
24. When assessing an older adult with macular de-
generation the nurse would expect to find
1. loss of central vision.
2. loss of peripheral vision.
3. total blindness.
4. blurring of vision.
25. A client states that she was told she has sen-
sorineural hearing loss and asks the nurse what this
means. The nurse's response is based on the knowledge
that sensorineural hearing loss results
from which of the following conditions?
1. Presence of fluid and cerumen in the external canal.
2. Sclerosis of the bones of the middle ear.
3. Damage to the cochlear or vestibulocochlear nerve.
4. Emotional disturbance resulting in a functional
hearing loss.
Oncology
1. The nurse is caring for a client with an internal
radiation implant. When caring for the client, the nurse
should observe which principle?
1. Limit the time with the client to 1 hour per shift.
2. Do not allow pregnant women into the client’s
room.
3. Remove the dosimeter film badge when entering the
clients room.
4. Individuals younger than 16 years old may be allowed
to go in the room as long as they are 6 feet away from
the client.
2. The female client who has been receiving radiation
therapy for bladder cancer tells the nurse that it feels as
if she is voiding through the vagina, The nurse interprets
that the client may be experiencing:
1. Rupture of the bladder
2. The development of a vesicovaginal fistula
3. Extreme stress caused by the diagnosis of cancer
4. Altered perineal sensation as a side effect of radiation
therapy
3. A gastrectomy is performed on a client with gastric
cancer In the immediate postoperative period, the nurse
notes bloody drainage from the nasogastric tube. Which
of the following is the appropriate nursing intervention?
1. Notify the physician.
2. Measure abdominal girth.
3. Irrigate the nasogastric tube.
4. Continue to monitor the drainage.
4. The nurse is teaching a client about the risk factors
associated with colorectal cancer. The nurse determines
that further teaching related to colorectal cancer is
necessary if the client identifies which of the following
as an associated risk factor?
1. Age younger than 50 years
2. History of colorectal polyps
3. Family history of colorectal cancer
4. Chronic inflammatory bowel disease
5. A nurse is caring for a client who had a prostatectomy
for prostate cancer. The nurse is reviewing the client’s
vital signs and intake and
output as documented by a nursing assistant. Which
documented finding requires immediate action?
1. Blood pressure
2. Heart rate
3. Ventricular standstill
4. Temperature
6. A client tells the nurse that she has found a painless
lump in her right breast during her monthly self-
examination. Which assessment finding
would strongly suggest that this client’s lump is
cancerous?
1. Eversion of the right nipple and mobile mass
2. Non-mobile mass with irregular edges
3. Mobile mass that is soft and easily delineated
4. Non-palpable right axillary lymph nodes
7. After being seen in the oncology clinic, a client with
severe bone marrow suppression is admitted to the
hospital. The client’s cancer therapy consisted of
radiation and chemotherapy. When developing the care
plan for this client, which nursing diagnosis takes
priority?
1. Risk for injury
2. Imbalanced nutrition: Less than body requirements
3. Risk for infection
4. Anxiety
8. While being prepared for a biopsy of a lump in the
right breast, the patient asks the nurse what the
difference is between a benign tumor and a malignant
tumor. The nurse explains that a benign tumor differs
from a malignant tumor in that benign tumors
a. do not cause damage to adjacent tissue.
b. do not spread to other tissues and organs.
c. are simply an overgrowth of normal cells.
d. frequently recur in the same site.
9. A patient who has been told by the health care
provider that the cells in a bowel tumor are poorly
differentiated asks the nurse what is meant by "poorly
differentiated." Which response should the nurse make?
a. "The cells in your tumor do not look very different
from normal bowel cells."
b. "The tumor cells have DNA that is different from your
normal bowel cells."
c. "Your tumor cells look more like immature fetal cells
than normal bowel cells."
d. "The cells in your tumor have mutated from the
normal bowel cells."
10. A patient who smokes tells the nurse, "I want to
have a yearly chest x-ray so that if I get cancer, it will be
detected early." Which response by the nurse is most
appropriate?
a. "Chest x-rays do not detect cancer until tumors are
already at least a half-inch in size."
b. "Annual x-rays will increase your risk for cancer
because of exposure to radiation."
c. "Insurance companies do not authorize yearly x-rays
just to detect early lung cancer."
d. "Frequent x-rays damage the lungs and make them
more susceptible to cancer."
11. In teaching about cancer prevention to a community
group, the nurse stresses promotion of exercise, normal
body weight, and low-fat diet because
a. most people are willing to make these changes to
avoid cancer.
b. dietary fat and obesity promote growth of many
types of cancer.
c. people who exercise and eat healthy will make other
lifestyle changes.
d. obesity and lack of exercise cause cancer in
susceptible people.
12. During a routine health examination, a 30-year-old
patient tells the nurse about a family history of colon
cancer. The nurse will plan to
a. teach the patient about the need for a colonoscopy at
age 50.
b. ask the patient to bring in a stool specimen to test for
occult blood.
c. schedule a sigmoidoscopy to provide baseline data
about the patient.
d. have the patient ask the doctor about specific tests
for colon cancer.
13. When reviewing the chart for a patient with cervical
cancer, the nurse notes that the cancer is staged as Tis,
N0, M0. The nurse will teach the patient that
a. the cancer cells are well-differentiated.
b. it is difficult to determine the original site of the
cervical cancer.
c. further testing is needed to determine the spread of
the cancer.
d. the cancer is localized to the cervix.
14. Which statement by a patient who is scheduled for a
needle biopsy of the prostate indicates that the patient
understands the purpose of a biopsy?
a. "The biopsy will tell the doctor whether the cancer
has spread to my other organs."
b. "The biopsy will help the doctor decide what
treatment to use for my enlarged prostate."
c. "The biopsy will determine how much longer I have to
live."
d. "The biopsy will indicate the effect of the cancer on
my life."
15. The nurse is teaching a postmenopausal patient with
breast cancer about the expected outcomes of her
cancer treatment. The nurse evaluates that the teaching
has been effective when the patient says
a. "After cancer has not recurred for 5 years, it is
considered cured."
b. "I will need to have follow-up examinations for
many years after I have treatment before I can be
considered cured."
c. "Cancer is considered cured if the entire tumor is
surgically removed."
d. "Cancer is never considered cured, but the tumor can
be controlled with surgery, chemotherapy, and
radiation."
16. A patient with a large stomach tumor that is
attached to the liver is scheduled to have a debulking
procedure. The nurse explains that the expected
outcome of this surgery is
a. control of the tumor growth by removal of malignant
tissue.
b. promotion of better nutrition by relieving the
pressure in the stomach.
c. relief of pain by cutting sensory nerves in the
stomach.
d. reduction of the tumor burden to enhance adjuvant
therapy.
17. External-beam radiation is planned for a patient with
endometrial cancer. The nurse teaches the patient that
an important measure to prevent complications from
the effects of the radiation is to
a. test all stools for the presence of blood.
b. inspect the mouth and throat daily for the
appearance of thrush.
c. perform perianal care with sitz baths and meticulous
cleaning.
d. maintain a high-residue, high-fat diet.
18. Which action by a nursing assistant (NA) caring for a
patient with a temporary radioactive cervical implant
indicates that the RN should intervene?
a. The NA places the patient's bedding in the laundry
container in the hallway.
b. The NA flushes the toilet once after emptying the
patient's bedpan.
c. The NA stands by the patient's bed for an hour
talking with the patient.
d. The NA gives the patient an alcohol-containing
mouthwash for oral care.
19. A patient with Hodgkin's lymphoma is undergoing
external radiation therapy on an outpatient basis. After
2 weeks of treatment, the patient tells the nurse, "I am
so tired I can hardly get out of bed in the morning." An
appropriate intervention for the nurse to plan with the
patient is to
a. exercise vigorously when fatigue is not as noticeable.
b. consult with a psychiatrist for treatment of
depression.
c. establish a time to take a short walk every day.
d. maintain bed rest until the treatment is completed.
20. Which information obtained by the nurse about a
patient with colon cancer who is scheduled for external
radiation therapy to the abdomen indicates a need for
patient teaching?
a. The patient swims a mile 5 days a week.
b. The patient eats frequently during the day.
c. The patient showers with Dove soap daily.
d. The patient has a history of dental caries.
21. A patient undergoing external radiation has
developed a dry desquamation of the skin in the
treatment area. The nurse knows that teaching about
management of the skin reaction has been effective
when the patient says
a. "I can use ice packs to relieve itching in the treatment
area."
b. "I can buy a steroid cream to use on the itching
area."
c. "I will expose the treatment area to a sun lamp daily."
d. "I will scrub the area with warm water to remove the
scales."
22. A patient with metastatic cancer of the colon
experiences severe vomiting following each
administration of chemotherapy. An important nursing
intervention for the patient is to
a. teach about the importance of nutrition during
treatment.
b. have the patient eat large meals when nausea is not
present.
c. administer prescribed antiemetics 1 hour before the
treatments.
d. offer dry crackers and carbonated fluids during
chemotherapy.
23. When the nurse is administering a vesicant
chemotherapeutic agent intravenously, an important
consideration is to
a. stop the infusion if swelling is observed at the site.
b. infuse the medication over a short period.
c. administer the chemotherapy through small-bore
catheter.
d. hold the medication unless a central venous line is
available.
24. A chemotherapeutic agent known to cause alopecia
is prescribed for a patient. To maintain the patient's
self-esteem, the nurse plans to
a. suggest that the patient limit social contacts until
regrowth of the hair occurs.
b. encourage the patient to purchase a wig or hat and
wear it once hair loss begins.
c. have the patient wash the hair gently with a mild
shampoo to minimize hair loss.
d. inform the patient that hair loss will not be
permanent and that the hair will grow back.
25. A patient with ovarian cancer tells the nurse, "I don't
think my husband cares about me anymore. He rarely
visits me." On one occasion when the husband was
present, he told the nurse he just could not stand to see
his wife so ill and never knew what to say to her. An
appropriate nursing diagnosis in this situation is
a. compromised family coping related to disruption in
lifestyle and role changes.
b. impaired home maintenance related to perceived role
changes.
c. risk for caregiver role strain related to burdens of
caregiving responsibilities.
d. interrupted family processes related to effect of
illness on family members.
26. A patient receiving head and neck radiation and
systemic chemotherapy has ulcerations over the oral
mucosa and tongue and thick, ropey saliva. An
appropriate intervention for the nurse to teach the
patient is to
a. remove food debris from the teeth and oral mucosa
with a stiff toothbrush.
b. use cotton-tipped applicators dipped in hydrogen
peroxide to clean the teeth.
c. gargle and rinse the mouth several times a day with
an antiseptic mouthwash.
d. rinse the mouth before and after each meal and at
bedtime with a saline solution.
27. A 40-year-old divorced mother of four school-age
children is hospitalized with metastatic cancer of the
ovary. The nurse finds the patient crying, and she tells
the nurse that she does not know what will happen to
her children when she dies. The most appropriate
response by the nurse is
a. "Why don't we talk about the options you have for
the care of your children?"
b. "Many patients with cancer live for a long time, so
there is time to plan for your children."
c. "For now you need to concentrate on getting well, not
worry about your children."
d. "Perhaps your ex-husband will take the children when
you can't care for them."
28. Which information noted by the nurse reviewing the
laboratory results of a patient who is receiving
chemotherapy is most important to report to the health
care provider?
a. Hemoglobin of 10 g/L
b. WBC count of 1700/µl
c. Platelets of 65,000/µl
d. Serum creatinine level of 1.2 mg/dl
29. After the nurse has explained the purpose of and
schedule for chemotherapy to a 23-year-old patient who
recently received a diagnosis of acute leukemia, the
patient asks the nurse to repeat the information. Based
on this assessment, which nursing diagnosis is most
likely for the patient?
a. Acute confusion related to infiltration of leukemia
cells into the central nervous system
b. Knowledge deficit: chemotherapy related to a lack of
interest in learning about treatment
c. Risk for ineffective health maintenance related to
anxiety about new leukemia diagnosis
d. Risk for ineffective adherence to treatment related to
denial of need for chemotherapy
30. A hospitalized patient who has received
chemotherapy for leukemia develops neutropenia.
Which observation by the RN caring for the patient
indicates that the nurse should take action?
a. The patient's visitors bring in some fresh peaches
from home.
b. The patient ambulates several times a day in the
room.
c. The patient uses soap and shampoo to shower every
other day.
d. The patient cleans with a warm washcloth after
having a stool.
31. Which action by a nursing assistant (NA) when caring
for a patient who is pancytopenic indicates a need for
the nurse to intervene?
a. The NA assists the patient to use dental floss after
eating.
b. The NA makes an oral rinse using 1 teaspoon of salt in
a liter of water.
c. The NA adds baking soda to the patient's saline oral
rinses.
d. The NA puts fluoride toothpaste on the patient's
toothbrush.
32. A with tumor lysis syndrome (TLS) is taking
allopurinol (Xyloprim). Which laboratory value should
the nurse monitor to determine the effectiveness of the
medication?
a. Blood urea nitrogen (BUN)
b. Serum phosphate
c. Serum potassium
d. Uric acid level
33. When assessing a patient's needs for psychologic
support after the patient has been diagnosed with stage
I cancer of the colon, which question by the nurse will
provide the most information?
a. "Can you tell me what has been helpful to you in the
past when coping with stressful events?"
b. "How long ago were you diagnosed with this cancer?"
c. "Are you familiar with the stages of emotional
adjustment to a diagnosis like cancer of the colon?"
d. "How do you feel about having a possibly terminal
illness?"
34. A client who’s receiving chemotherapy for breast
cancer develops myelosuppression. Which instructions
should the nurse include in the client’s discharge
teaching plan? Select all that apply.
1. Avoid people who have recently received attenuated
vaccines.
2. Avoid activities that may cause bleeding.
3. Wash hands frequently.
4. Increase intake of fresh fruits and vegetables.
5. Avoid crowded places such as shopping malls.
6. Treat a sore throat with over-the-counter (OTC)
products.
35. A client suspected of having colorectal cancer
requires which diagnostic study to confirm the
diagnosis?
1. Stool Hematest
2. Carcinoembryonic antigen (CEA)
3. Sigmoidoscopy
4. Abdominal computed tomography (CT) scan
36. To combat the most common adverse effects of
chemotherapy, a nurse should administer an:
1. antiemetic.
2. antimetabolite.
3. antibiotic.
4. anticoagulant.
37. Which statement by a client undergoing external
radiation therapy indicates the need for further
teaching?
1. “I’ll wash my skin with mild soap and water only.”
2. “I’ll not use my heating pad during my treatment.”
3. “I’ll wear protective clothing when outside.”
4. “I’m worried I’ll expose my family members to
radiation.”
38. A client with metastatic ovarian cancer is ordered
cisplatin (Platinol). Before administering the first dose,
the nurse reviews the client’s medication history for
drugs that may interact with cisplatin. Which drug may
cause significant interactions when given concomitantly
with cisplatin?
1. Erythromycin
2. A tetracycline
3. A cephalosporin
4. An aminoglycoside
39. A client receiving external radiation to the left
thorax to treat lung cancer has a nursing diagnosis of
Risk for impaired skin integrity. Which intervention
should be part of this client’s care plan?
1. Avoiding using soap on the irradiated areas
2. Applying talcum powder to the irradiated areas daily
after bathing
3. Wearing a lead apron during direct contact with the
client
4. Removing thoracic skin markings after each radiation
treatment
40. A client is receiving chemotherapy to treat breast
cancer. Which assessment finding indicates a
chemotherapy-induced complication?
1. Urine output of 400 ml in 8 hours
2. Serum potassium level of 2.6 mEq/L
3. Blood pressure of 120/64 to 130/72 mm Hg
4. Sodium level of 142 mhq/L
41. A client receives a sealed radiation implant to treat
cervical cancer. When caring for this client, the nurse
should:
1. consider the client’s urine, feces, and vomitus to be
highly radioactive.
2. consider the client to be radioactive for 10 days after
implant removal.
3. allow soiled linens to remain in the room until after
the client is discharged.
4. maintain the client on complete bed rest
42. A client is undergoing a left modified radical
mastectomy for breast cancer. Postoperatively, blood
pressure should be obtained from the right arm, and the
client’s left arm and hand should be elevated as much as
possible to prevent which condition?
1. Lymphedema
2. Trousseau’s sign
3. I.V. infusion infiltration
4. Muscle atrophy
42. A client with stage II ovarian cancer undergoes a
total abdominal hysterectomy and bilateral salpingo-
oophorectomy with tumor resection,
omentectomy, appendectomy, and lymphadenectomy.
During the second postoperative day, which assessment
finding requires immediate
intervention?
1. Abdominal pain
2. Hypoactive bowel sounds
3. Serous drainage from the incision
4. Shallow breathing and increasing lethargy
43. A client who will have his last chemotherapy cycle in
11 days becomes neutropenic. The client understands
his condition when he states:
1. “I’ll monitor my temperature frequently and go to
the nearest emergency department if my temperature
rises above 100.4°F.
2. “I’ve found that eating fresh fruit and vegetables
reduces the side effects of chemotherapy and also gives
me more energy.”
3. “I find that going out for a quiet dinner and a movie
relieves the stress and anxiety of my cancer treatment.”
4. “I love working in my garden; it gives me a lot of inner
peace and tranquility.”
44. A nurse is administering daunorubicin (Daunoxome)
through a peripheral I.V. line when the client complains
of burning at the insertion site. The nurse notes no
blood return from the catheter and redness at the IV.
site. The client is most likely experiencing which
complication?
1. Erythema
2. Flare
3. Extravasation
4. Thrombosis
45. For a client newly diagnosed with radiation-induced
thrombocytopenia, the nurse should include which
intervention in the care plan?
1. Administering aspirin if the temperature exceeds 102°
F (38.8° C)
2. Inspecting the skin for petechiae once every shift
3. Providing for frequent rest periods
4. Placing the client in strict isolation
46. A client is scheduled to receive methotrexate
(Trexall), 0.625 mg/kg P.O. daily, to treat malignant
lymphoma. Before administering the
drug, the nurse reviews the client’s medication history.
Which drug might interact with methotrexate?
1. Digoxin (Lanoxin)
2. Theophylline (Slo-Phyllin)
3. Probenecid (Probalan) drugs (NSAIDs) and initiation of an exercise program.
4. Famotidine (Pepcid) 3. administration of monthly intra-articular injections of
corticosteroids.
47. A client with a nagging cough makes an appointment 4. vigorous physical therapy for the joints.
to see the physician after reading that this symptom is
one of the seven warning signs of cancer. What is 3. A nurse is caring for a client with burns on his legs.
another warning sign of cancer? Which nursing intervention will help to prevent
1. Persistent nausea contractures?
2. Rash 1. Applying knee splints
3. Indigestion 2. Elevating the foot of the bed
4. Chronic ache or pain 3. Hyperextending the client’s legs
4. Performing shoulder range-of-motion (ROM)
48. A client with laryngeal cancer has undergone exercises
laryngectomy and is now receiving radiation therapy to
the head and neck. The nurse should 4. A client is in the emergency department with a
monitor the client for which adverse effects of external suspected fracture of the right hip. Which assessment
radiation? Select all that apply. findings should the nurse expect? Select all that apply.
1. Xerostomia 1. The right leg is longer than the left leg.
2. Stomatitis 2. The right leg is shorter than the left leg.
3. Thrombocytopenia 3. The right leg is abducted.
4. Cystitis 4. The right leg is adducted.
5. Dysgeusia 5. The right leg is externally rotated.
6. Leukopenia 6. The right leg is internally rotated.

49. A client with carcinoma of the lung develops
syndrome of inappropriate antidiuretic hormone
(SIADH) as a complication of the cancer. The nurse
anticipates that which of the following may be
prescribed? Select all that apply.
1. Radiation
2. Chemotherapy
3. Increased fluid intake
4. Serum sodium levels
5. Decreased oral sodium intake
6. Medication that is antagonistic to antidiuretic
hormone
5. After a car accident, a client is admitted to an acute
care facility with multiple traumatic injuries, including a
fractured pelvis. For 24 to 48 hours after the accident,
the nurse must monitor the client closely for which
potential complication of a fractured pelvis?
1. Compartment syndrome
2. Fat embolism
3. Infection
4. Volkmann’s ischemic contracture

50. A nurse is preparing a list of home care instructions

regarding stoma and laryngectomy care to a client who
had a laryngectomy. Which instructions would be
included in the list? Select all that apply.
1. Avoid swimming and use care when showering.
2. Keep the humidity in the home low.
3. Avoid exposure to people with infections.
4. Restrict fluid intake.
5. Obtain a Medic-Alert bracelet.
6. Prevent debris from entering the stoma.

Ortho

1. A client complains that he experiences pain and

numbness in his fingers when he types on a computer
keyboard. Which action will help the nurse assess for
Phalen’s sign?
1. Having the client hold both hands above his head with
his arms straight for 30 seconds
2. Having the client hold both wrists in acute flexion
with the dorsal surfaces touching for 60 seconds
3. Tapping gently over the median nerve in the wrist
4. Having the client extend his wrists while the nurse
provides resistance

2. A nurse is managing the care of a client with

osteoarthritis. Appropriate treatment strategies for
osteoarthritìs include:
1. administration of opioids for pain control.
2. administration of nonsteroidal anti-inflammatory