NUTRITION

1. A client is admitted for treatment of Crohn’s disease. Which information is most significant when the nurse
assesses nutritional health?
A. Health history: eating behaviors and patterns
B. Physical examination: hair, skin, nails, tongue, teeth
C. Lab tests: CBC, urinalysis
D. Anthropometric measurements
 Anthropometric measurements are the prime parameters used to evaluate fat and muscle stores in the
body
 - Height/weight ratio (Body Mass Index)
 - Mid-arm muscle circumference
 - Skinfold thickness (triceps, biceps, subscapular, abdominal, hip, pectoral, calf)
2. Total parenteral nutrition (TPN) is ordered for an adult client. Which statement is true regarding TPN?
A. It contains 20-70% glucose
B. The RN will mix the lipids into the TPN bag before administration
C. When the client’s blood glucose runs high, decrease the TPN rate
D. Check the client’s potassium level every 6 hours
 - Total Parenteral Nutrition
 > through a central vein catheter (larger caliber, higher blood flow will quickly dilute hyperalimentation
solution to isotonic concentration)
 > Hyperalimentation solutions
 - hypertonic glucose of 20-70%, amino acids, water, vitamins, minerals with lipid emulsions given in a
separate solution
 - 3-in-1 solutions: lipids mixed with dextrose and amino acids (prepared by pharmacy in a 3-liter
container administered over 24 hrs)
 - IV Lipid Emulsions
 > given peripherally or through central vein
 > to prevent essential fatty acid deficiency in long-term TPN clients or provide supplemental kcal
 - Peripheral Vein Parenteral Nutrition (PPN)
 > short-term nutritional support when central vein is unavailable
 > same components with TPN but lower glucose concentrations (<20%)
3. An adult is receiving TPN. The nurse knows which of the following assessments is essential?
A. Evaluation of the peripheral IV site
B. Confirmation that the tube is in the stomach
C. Assessment of the GIT including bowel sounds
D. Fluid and electrolyte monitoring
 Clients receiving TPN can experience electrolyte imbalances, hypo- or hyperglycemia
4. Machete, a body builder was asking a nurse what food is high protein yet low cost. The nurse would confidently
say:
A. Bacon, fried rice and egg (Bacsilog)
B. Spaghetti
C. Peas and beans
D. Bangus, fried rice and egg (Bangsilog)
 Bacon contains the highest kilocalorie as it is from the fat group
 Fats yield 9kcal/g, whereas the carbohydrate and protein groups only yield 4 kcal/g
5. The nurse knows that a client understands a low residue diet when he selects which of the following from a
menu?
A. Rice and lean chicken
B. Strawberry pie
C. Pasta with vegetables
D. Tuna casserole
 Residue is the indigestible substances left in GIT after food has been digested (fiber, foods with skins and
seeds, milk and milk products)
 Indications: prior to lower bowel examination to enhance visualization;, colorectal surgery to reduce
pressure on post-op site; internal radiation for cervical cancer; Crohn’s disease or ulcerative colitis to
reduce irritation of large bowel; and diarrhea
 A low-residue diet includes rice, lean meats and eggs
6. Which of the following foods should a patient with gout avoid or omit in his diet?
A. Eggs
B. Loaf bread
C. Liver
D. Coffee
7. Reduction in dietary intake of fats is beneficial because it prevents which of the following
diseases:
1. Myocardial Infarction
2. Cancer
3. Appendicitis
4. Cholelithiasis
5. Kidney failure
A. 1, 2 and 4
B. 2, 3 and 5
C. 1, 4 and 5
D. 1, 2 and 5
E. 1, 2, 3, 4 and 5
8. Diet is an important factor in the control of blood cholesterol, which of the following food choices is appropriate
for a client on a low cholesterol diet?
A. One serving Beef kaldereta with two cups of rice
B. One piece Pork liempo chopped with a serving of chopsuey and one cup of rice
C. One serving of Chicken Pastel with one cup of rice
D. One piece of Baked Chicken fillet with two and a half cup of rice
 Chicken fillet is low in cholesterol, baking does not use additional oil
9. Which advice would be appropriate for the nurse to give to a client with dumping syndrome?
A. Take a drink after every four to five bites of food at a meal
B. Eat several small meals per day of wet foods
C. Remain in an upright position for 30–60 minute after eating
D. Avoid foods that are concentrated carbohydrates
 Foods that are concentrated carbohydrates should be avoided.
 Dumping syndrome has vasomotor (tachycardia, diaphoresis, flushing, weakness, palpitations, and anxiety)
10. A mother asks that nurse what food is safe for her toddler. Knowing that children can easily choke on food, the
nurse should advise the mother to feed the toddler which of the following?
A. Salted nuts
B. Grilled hotdogs
C. Caramelized popcorn
D. Cereals like cheerios

CARE OF CLIENT IN PAIN

Pain, considered as the 5th vital sign is an unpleasant sensation, entirely subjective, that produces discomfort,
distress, or suffering.
11. The nurse has administered analgesia, but the client continues to complain of severe pain. Which of the
following actions should be most appropriate for the nurse to take first?
A. Contact the physician to request additional medication
B. Assist the client to a comfortable position and help her relax
C. Administer a narcotic analgesic
D. Inform the client that she may request additional pain medication in 3 hours
 Medication is usually more effective with relieving techniques
 Many basic nursing measures reduce or eliminate discomfort
 Administering analgesia alone does not replace thoughtful, comprehensive pain management
12. Pre-op teaching plan for an adult who is to have patient controlled analgesia (PCA) following surgery includes
telling the client:
A. “You will not be drowsy”
B. “You will experience no pain
C. “Pain control will be adequate”
D. “You will not have incisional pain but you may have muscle pain”
 Clients should be told that they will be able to control their pain
13. The client’s family expresses concern that the client could overdose with a PCA. What protective mechanism
prevents drug overdose with a PCA?
A. The nurse controls the amount administered with each dose
B. Extensive client teaching precedes its use
C. The client can stop drug administration but not initiate it
D. After a bolus is administered, there is a mandatory waiting period before another dose is given
 Immediately after a bolus dose of medication is administered the device enters a mandatory lockout mode
where no other boluses of medication can be delivered
14. An adult is to receive an IM injection of Fentanyl for post-op pain. Which of the following is necessary for the
nurse to assess prior to giving a narcotic analgesic?
A. The client’s level of alertness and respiratory rate
B. The last time the client ate or drank something
C. The client’s bowel habits and last bowel movement
D. The client’s history of addictions
 Fentanyl (Sublimaze) is a potent narcotic analgesic with a rapid onset and short duration of action.
Historically it has been used to treat chronic breakthrough pain and is commonly used pre-procedures.
 Fentanyl is approximately 100 times more potent than morphine, with 100 micrograms of Fentanyl
approximately equivalent to 10 mg of morphine in analgesic activity
 A decreasing level of alertness can signal early respiratory depression and a significant drop in the RR is a
warning sign
15. A client with an acute exacerbation of rheumatoid arthritis (RA) is admitted to the hospital for treatment. Which
drug, used to treat clients with RA has both an anti-inflammatory and immunosuppressive effect?
A. Gold sodium thiomalate (Myochrysine)
B. Azathioprine (Imuran)
C. Prednisone (Deltasone)
D. Naproxen (Naprosyn)

CARE OF CLIENT WITH FLUID AND ELECTROLYTES, AND ACID-BASE IMBALANCE

16. A 78 y/o male has been working on his lawn for 2 days, although his temperature has been 37.8. He has been on
Thiazide diuretics for hypertension. His lab values are: K 3.7 mEq/L; Na 129 mEq/L; Cl 95 mEq/L; Ca 9.9 mg/dL. What
would be a priority action for this man?
A. Make sure he drinks 8 glasses of water a day
B. Monitor for fatigue, muscle weakness, restlessness, and flushed skin
C. Look for signs of hyperchloremia
D. Observe for neurologic changes
 Neurologic changes can occur from hyponatremia
 They include confusion, disorientation, lethargy, seizures and coma
17. An adult suffered 2nd and 3rd degree burns over 20% of his body 2 days ago. What is the best way to assess the
client’s fluid balance?
A. Maintain strict records of intake and output
B. Weigh the client daily
C. Monitor skin turgor
D. Check for edema
 This is the best way to assess fluid balance, especially acute changes in those with large losses or acutely ill
18. An adult who is anxious has blood gases of pH 7.47; PaCO2 33. What is the best initial action for the nurse to
take?
A. Try to have the client breath slower or into a paper bag
B. Monitor the client’s fluid balance
C. Give O2 via nasal cannula
D. Administer sodium bicarbonate
 The client is in respiratory alkalosis and needs to increase the carbon dioxide
 The easiest way to do this is to try and calm the client and/or have him breath in and out of a paper bag,
thus inhaling the exhaled carbon dioxide
19. An adult has had gastroenteritis for 3 days. He has taken baking soda without relief. His blood gases are as
follows: pH 7.49; PaCO2 45; and HCO3 30. The nurse would expect which of the following to be included in the plan
of care?
A. Have the client drink at least 8 glasses of water in the first day
B. Administer NaHCO3 IV as per physician’s order
C. Continue baking soda for nausea
D. Monitor electrolytes for hypokalemia and hypocalcemia
 Hypokalemia and hypocalcemia are both common with metabolic alkalosis as a result of cellular buffering
20. An adult has an IV line in the right forearm infusing D5 ½ NS with 20 mEq of potassium at 75 mL/h. Which
statement would be a correct report from the RN?
A. The potassium bag is piggybacked into the dextrose at 75 mL/h
B. The clamp should be closed below the D5 ½ NS bag
C. Potassium is on the secondary line
D. 75 mL will infuse in 1 hour
 The IV fluids will infuse 75 mL/h, as the rate states
 The potassium has already been mixed in the bag from pharmacy and infuses from one bag
CARE OF ELDERLY CLIENTS
Aging is a normal developmental process occurring throughout the human life span that causes a mild progressive
decline in body system functioning. The older client is generally regarded as one who is 65 years of age or older.
21. Which is a normal sign of aging in the renal system?
A. Intermittent incontinence
B. Concentrated urine
C. Microscopic hematuria
D. A decreased glomerular filtration rate
 The glomerular filtration rate is decreased dramatically in the elderly due to changes in the renal tubules
22. The community health nurse is making an initial home visit for an elderly client to assess the client’s ability to
provide self-care in the home. Which one of the following areas of concern should be assessed for determining the
client’s ability to remain at home?
A. Elimination
B. Cognitive abilities
C. Exercise
D. Metabolism
 Alzheimer’s disease is the most common cognitive impairment affecting older adults
 As the disease progresses, it requires ongoing assessment to determine the client’s ability to maintain
himself in the home environment
 All other needs will depend on his cognitive abilities
23. An elderly client is in for her annual health check-up. Which of the following findings during the physical
assessment is of greatest concern to the nurse?
A. Kyphosis
B. Sluggish bowel sounds
C. Painful sexual intercourse
D. Hyperactive deep-tendon reflexes
 Clonus is a phenomenon where reflexes are very hyperactive and suggests the presence of CNS disease
 This requires further evaluation
 The other findings are a normal process of aging
24. When working with groups of older clients in a day care setting, the nurse can promote socialization best by
implementing which of the following interventions?
A. Grouping clients together by age and gender to encourage the development of friendships based on a common
characteristic
B. Assign a different nurse to group activities each day to familiarize client with staff
C. Avoid discussion of client’s life outside the day care setting to encourage participation in current activities
D. Get to know the clients and accompany them to group events such as singing, crafts or communal meals
 Socialization is fostered when nurses and other caregivers take time to talk with the clients and show a
genuine concern for their well-being, for their present and past life stories
 There is no need to separate by age or gender
 Continuity of care has proven to enhance client outcomes
25. An elderly client who has diabetes mellitus and severe cataracts has been given instructions for administering
insulin. Which of the following client behaviors signals to the nurse that he has a need for assistance with
administration of his insulin?
A. He uses a magnifier to read the insulin syringe
B. He states he will pinch the skin at the site and inject the insulin at a 90 degree angle
C. He mixes NPH and regular insulins by drawing up the NPH first
D. He rotates sites only after using all available areas within each site
 The correct preparation of insulin should be: the regular (clear) insulin is drawn up first, then the NPH
(cloudy)
 This action is performed to keep the short-acting regular insulin free from potential “contamination” by the
intermediate-acting NPH
 Remember “clear to cloudy”

PERIOPERATIVE NURSING CARE

26. The nurse administers 10 mg IM morphine as a pre-op medication, and then discovers that there is no signed
operative consent. What is the best action for the nurse to take?
A. Send the client to surgery as scheduled
B. Notify the nursing supervisor, the physician and the OR
C. Cancel the surgery immediately and notify the OR, anesthesiologist and surgeon
D. Obtain the needed consent
 If a narcotic, sedative, or tranquilizer has been administered before signing of the consent, the drug’s
effects must be allowed to wear off before consent can be given
 In the meantime, it is most appropriate to inform the nurse supervisor, physician and OR
27. An adult who has COPD is scheduled for surgery and the physician has recommended an epidural anesthetic.
Why would an epidural anesthetic be used instead of general anesthesia?
A. There is too high a risk for pressure sores developing
B. There is less effect on the respiratory system with epidural anesthesia
C. CNS control of vascular constriction would be affected with general anesthesia
D. There is too high a risk of lacerations to the mouth, bruising of lips, and damage to teeth
 Epidural anesthesia does not cause respiratory depression, but general anesthesia can, especially in a client
with COPD
28. An adult received Droperidol and Fentanyl (Innovar) during surgery. In planning post-op care, the nurse will
need to monitor for which of the following during the immediate post-op period?
A. Restlessness and anxiety
B. Delirium
C. Dysrhythmias
D. Respiratory depression
 Depression of RR has been reported and tends to last longer than the analgesic effect when Fentanyl is
used during surgery
29. A 58 y/o smoker underwent major abdominal surgery 2 days ago. During the respiratory assessment, the nurse
notes he is taking shallow breaths and breath sounds are decreased in the bases. What is the best interpretation for
these findings?
A. Pneumonia
B. Pulmonary embolism
C. Atelectasis
D. Hemorrhage
 Atelectasis occurs commonly after abdominal surgery, especially in smokers
 This occurs when mucus blocks the bronchioles and causes decreased breath sounds and shallow breathing
30. It is 10:00 PM and the nurse notes that an adult male who returned from the PACU at 2:00 PM has not voided.
The client has an out of bed order, but has not been up yet. What is the best action for the nurse to take?
A. Insert a Foley catheter into the client
B. Straight-catheterize the client
C. Assist the client to stand at the side of his bed and attempt to void into a urinal
D. Encourage the client to lie on his left side in bed and attempt to void into a urinal
 Nursing intervention to facilitate voiding include ambulation and normal positioning for voiding, which is
standing
31. Inside the operating room, the circulating nurse noticed that the student nurse’s curly hair is uncovered by the
OR cap. What would be the best action for the circulating nurse to do?
A. Tell the student nurse to go out
B. Tell the clinical instructor and let him/her fix it
C. Approach the student nurse and tell her to fix it outside the room
D. Leave it as it will not cause any danger

32. After scrubbing for an explore lap, you found Doc Reyes getting inside the OR with the usual swinging of hands.
As a scrub nurse, what will you do?
A. Greet him, “Good morning, Doc Reyes, I notice that you look handsome today”, smile, and go on preparing the
Mayo table
B. Offer Doc Reyes a size 6 sterile gloves and assist him in gowning
C. Inform your supervisor
D. Tell Doctor Reyes to scrub again
33. Which of the following is an post-operative effect of general anesthesia?
A. Food tolerance
B. Neurogenic shock
C. Excessive flatus
D. Paralytic ileus

CARE OF CLIENTS WITH CARDIOVASCULAR AND HEMATOLOGIC DISORDERS

34. The nurse is caring for a client being treated for a myocardial infarction. Oxygen is ordered. Administering
oxygen to this client is related to which of the following client problems?
A. Anxiety
B. Chest pains
C. Ineffective myocardial perfusion
D. Alteration in heart rate, rhythm, or conduction
 With acute MI there is ineffective myocardial perfusion, resulting in a decrease in the amount of oxygen
available for tissue perfusion
 Oxygen is administered to improve tissue perfusion in these clients
35. A 57 y/o is being treated in the clinic for hypertension. His BP is 170/92 and he is complaining of fatigue and
lassitude. He has been taking Propranolol (Inderal) 80 mg BID. What action by the client will assure the nurse that
teaching has been successful?
A. Checks his pulse for bradycardia
B. Makes an appointment as soon as he notices fatigue
C. Stops the drug when he experiences chest pain
D. Takes the drug with breakfast and dinner
 A common side effect of Propranolol is slowed pulse rate because the drug is a beta blocker
36. A 56 y/o obese man is recovering from a bowel resection for cancer of the colon. On his 3rd post-op day he
complains that the area around the calf of his leg is warm and tender. What assessment will the nurse observe that
will suggest the client has a deep vein thrombosis?
A. Absence of a pulse distal to the clot
B. Cyanosis distal to the clot
C. Pain on dorsiflexion
D. Reddened area around the clot
 Pain on dorsiflexion is a common manifestation of DVT
37. A client is admitted in cardiogenic shock. What will be inserted to best evaluate the heart’s hemodynamic
performance?
A. Intra-arterial line
B. Pulmonary artery catheter
C. Intra-aortic balloon pump (IABP)
D. Triple lumen catheter
 A pulmonary artery catheter will show all right and left heart hemodynamic pressures and provide for
cardiac output measurements
38. Lidocaine is mixed 2 g in 500 mL D5W. The nurse prepared to start an infusion at 2 mg/h using a 60-drop tubing.
Which of the following is the correct rate to start the infusion on a pump?
A. 15 mL
B. 30 mL
C. 45 mL
D. 60 mL
 30 mL is 2 mg/h
 1000 mg = 1 g 2 g is 200 mg
 2000 mg : 500 mL :: 2 mg : x mL
 2000 x = 1000
 X =0.5 mL/hr
 60 drops = 1 mL 60 drops x 0.5 mL
 = 30 mL/hr
39. The nurse should interpret a weight gain of 5.5 lbover 24 hours in a client with a biologic cardiac valve
replacement as a sign of the development of which problem?
A. Graft rejection
B. Pericarditis
C. Congestive heart failure
D. Pyelonephritis
 Weight gain, dyspnea, and tachycardia are symptoms of CHF, which can occur with graft failure.
 Hyperacute graft rejection is almost exclusively limited to transplanted kidneys and is a rare event because
of careful cross matching before transplant.
40. What type of arterial aneurysm is a symmetric, spindle-shaped expansion of entire circumference of the artery?
A. Saccular
B. Dissecting
C. False
D. Fusiform
 Saccular aneurysm is a bulbous protrusion of one side of the arterial wall.
 Dissecting aneurysm is a hematoma that splits the layers of the arterial wall.
 False aneurysm is a pulsating hematoma, the clot and connective tissue are outside the arterial wall
41. Aortic dissection IIIB is indicative of:
A. Involve the proximal aorta, arch, and descending thoracic aorta.
B. Ascending aorta only
C. Originate in the descending thoracic and thoracoabdominal aorta
D. Ascending aorta and aortic arch involvement
 DeBakey type I and Stanford type A include dissections that involve the proximal aorta, arch, and
descending thoracic aorta.
 DeBakey type II only involves the ascending aorta; this dissection is included in Stanford type A.
 DeBakey type III and Stanford type B include dissections that originate in the descending thoracic and
thoracoabdominal aorta regardless of any retrograde involvement of the arch.
  These are subdivided into a and b depending on abdominal aortic involvement.
42. A nurse is noting for Fibrillation on the ECG, which is characterized by:
A. "Sawtooth" appearance of P wave
B. Flat P wave
C. P wave appears before QRS and after
D. Undetermined P wave
43. Which of the following is a sign of irreversible shock?
A. Cold and clammy skin
B. Anuria
C. Rapid pulse
D. Restlessness
44. What components in the blood are elevated in patients with polycythemia vera?
A. RBC, WBC, platelets
B. RBC, bilirubin, platelets
C. RBC, BUN, creatinine
D. RBC, glutamic acid, hemoglobin
45. The following are clinical manifestations of polycythemia EXCEPT:
A. Ruddy complexion
B. Hepatomegaly
C. Splenomegaly
D. Pruritus
46. Patients with polycythemia often experience generalized pruritus. To control itching, which should not be
recommended?
A. Bathing in tepid or cool water
B. Applying cocoa butter-based lotions and bath products
C. Taking antihistamines
D. Minimizing alcohol intake
47. What is a particularly important part of therapy in polycythemia to keep the hematocrit in normal range?
A. Performing phlebotomy repeatedly once or twice weekly
B. Instructing the patient to take iron supplements, including those within multivitamin supplements
C. Administering Allopurinol (Zyloprim)
D. Using chemotherapeutic agents to induce marrow function
48. What is the purpose of phlebotomy in a patient with polycythemia vera?
A. To maintain normal blood pressure
B. To maintain normal hematocrit
C. To decrease excessive iron absorption
D. To maintain fluid volume
51. A client presents with pericardial friction rub and was diagnosed to have pericarditis. The nurse would help
relieve pain by placing the patient in what recommended position?
A. Prone
B. Supine
C. Either side Left or Right with head elevated by pillows
D. Sitting upright and leaning forward

CARE OF PATIENTS WITH RESPIRATORY DISORDERS

52. A client in the ICU was intubated because of ARDS. What must be the cuff pressure of an endotracheal tube to
minimize the risk of tracheal tissue necrosis?
A. 15-20 mm Hg
B. 20-25 mm Hg
C. 25-30 mm Hg
D. 30-35 mm Hg
53. The nurse knows that the amount of air delivered to the patient during ventilator breath pertains to:
A. Tidal volume
B. Inspiratory reserve volume
C. Vital capacity
D. Oxygen saturation

CARE OF THE PATIENTS WITH GASTRO-INTESTINAL TRACT PROBLEMS

54. Also known as “biliary colic”, the typical manifestation of gallbladder disease like cholecystitis and cholelithiasis
is:
A. Right upper quadrant pain
B. Left lower quadrant pain
C. Right lower quadrant pain
D. Left upper quadrant pain
55. The most accurate and choice diagnostic test to confirm the presence of gallstones is:
A. Ultrasound
B. Cholecystography
C. Endoscopy
D. Abdominal X-ray
56. What do you call the surgical removal of stones from the common bile duct?
A. Choledochostomy
B. Cholecystectomy
C. Lithotripsy
D. Choledocholithiasis
57. Cholesterol stones are common especially among Americans because of their diet. The maximum normal serum
cholesterol should be:
A. 100 mg/dL
B. 150 mg/dL
C. 200 mg/dL
D. 250 mg/dL
58. Aside from causing gallstones, increased cholesterol level is also risk factor for heart disease. Which of the
following interventions can lower cholesterol in the blood?
1. Diet rich in oats and wheat
2. Concomitant use of tobacco
3. Alcohol intake
4. Daily jogging
5. Smoking cessation
A. 2 and 5
B. 1, 3, 5
C. 1 and 4
D. 1 and 5
 a high fiber diet lowers cholesterol
 while jogging enhances the metabolism of cholesterol
 smoking cessation does not affect cholesterol levels
59. The client with coronary artery disease is prescribed Lipitor to help decrease the client’s cholesterol level.
Which intervention should the nurse discuss with the client concerning this medication?
A. The client should eat a low-cholesterol, low-fat diet
B. The client should take this medication with each meal
C. The client should avoid getting pregnant when taking this drug
D. The client should monitor daily cholesterol levels
 The drug is pregnancy category X. It is teratogenic
60. When caring for a client with pruritus related to jaundice due to liver cirrhosis, which intervention is appropriate
for the nurse to recommend?
A. Apply skin moisturizer
B. Dab alcohol onto the itchy areas
C. Take frequent, warm baths
D. Drink tea
 Application of moisturizers to prevent drying helps limit pruritus.
 Alcohol is drying so it aggravates the itch.
 Cool baths can soothe itch; warm baths increase it.
 Drinking tea is contraindicated because it contains caffeine and Theophylline, which increase itch.
61. Peritonitis typically manifest with all of the following EXCEPT:
A. Shortness of breath
B. Soft tender abdomen
C. Fever
D. Board like abdomen
62. A patient is to undergo Billroth II procedure. It is s an operation in which the pyloric antrum is removed and a
loop of small bowel is brought up and joined to it in a side-to-side manner for drainage. The procedure is also
called:
A. Gastroduodenostomy
B. Gastrojejunostomy
C. Gastroileostomy
D. Gastrocolostomy
63. After billroth 2, the patient complained of nausea, vomiting and abdominal distension, the nurse would expect
to prepare the patient for:
A. Endoscopy
B. CBC
C. Gastric decompression
D. Rectal tube insertion

CARE OF THE PATIENTS WITH ENDOCRINE PROBLEMS

64. When caring for a postoperative client who has had a thyroidectomy, which medication should the nurse ensure
is immediately available at the bedside?
A. Calcium gluconate
B. Propylthiouracil
C. KISS (Potassium Iodide Solution)
D. Synthroid
 Calcium gluconate should be immediately available at the bedside of a client who has had a thyroidectomy
because of the risk of hypocalcemic tetany.
 Propylthiouracil, an antithyroid drug, blocks synthesis of thyroid hormone and is used in the treatment of
hyperthyroidism.
 KISS decreases blood flow to the thyroid gland.
 Synthroid is a thyroid hormone replacement drug and is used in the treatment of hypothyroidism.
65. In which situation would the nurse check Chvostek’s and Trousseau signs?
A. Client complains of calf pain
B. Client complains of headache and photophobia
C. Client complains of weakness and dysphagia
D. Client complains of spasm
66. Jenny, 27 years old has Grave's disease. After an interview and physical assessment, the following information is
expected:
A. Tachycardia, heat tolerance, weight loss and amenorrhea
B. Constipation, heat intolerance, and weight loss
C. Tachycardia, diarrhea, and decrease body temperature
D. Tachycardia, protruding eyeballs and profuse sweating
67. A female patient with manifestation of hyperthyroidism is scheduled for RAIU test, which of the following is
priority assessment?
A. When was your last alcohol intake?
B. Are you allergic to barium?
C. When did your symptoms started?
D. When was your last menstrual period?
 Radioactive Iodine Uptake is radioactive. Possible pregnancy may prevent the test.
 The radioactive iodine uptake test measures the rate of iodine uptake by the thyroid gland.
 The patient is administered a tracer dose of iodine 123 (123I) or another radionuclide, and a count is made
over the thyroid gland with a scintillation counter, which detects and counts the gamma rays released from
the breakdown of 123I in the thyroid.
68. A client with acromegaly is being treated with Octreotide (Sandostatin), a Somatostatin analogue used to
suppress growth hormone. He is now ready for discharge. The nurse would instruct the client that Octreotide will
be administered via:
A. Oral
B. SQ
C. IM
D. IV
69. The nurse would also instruct the client taking Octreotide which common side effects?:
A. Constipation
B. Tachycardia
C. Physical dependence
D. Pancreatitis
70. Mr. Restituto Maliksi, a type 2 diabetic patient is taking Metformin and he is scheduled to undergo a contrast CT
scan to rule out another abnormal condition. The nurse knows that before the procedure, Metformin will be:
A. Increase the dosage because the patient will undergo another test to prevent lactic acidosis.
B. Stop the medication 8 hours before the procedure then continue 8 hours after the procedure.
C. Low the dosage of metformin because the effect will be metabolic acidosis
D. Withdraw the metformin 48 hours before the procedure and for 48 hours after the procedure.
71. A patient with type 2 DM is taking Chlorpropamide to control blood glucose level. All of the following statement
is true in giving chlorpropamide except:
A. Instruct the patients to avoid use of alcohol
B. When taken with beta blocker may mask usual warning s/sx of hypoglycemia
C. Monitor the patient for renal insufficiency
D. Monitor the patient for signs of hypoglycemia and lactic acidosis
72. A nurse is assisting in preparing a teaching plan for the client with diabetes mellitus regarding proper foot care.
Which of the following instructions should be included in the plan?
A. Soak feet in hot water
B. Filing sharp corners of the nail to follow the contour of the toe
C. Always have a podiatrist cut your toenails, never cut them yourselves
D. Avoid using soap on the feet

CARE OF THE PATIENTS WITH CANCER

73. When teaching about cancer detection, which factors should the nurse identify as predisposing a woman to
breast cancer? (Select all that apply.)
1. Family history of breast cancer, particularly in first-degree maternal relatives (mother, sister,
and/or maternal aunt)
2. Positive tests for genetic mutations (BRCA 1 and BRCA 2)
3. Long menstrual cycles
4. Early menarche and early menopause
5. Height 5 feet 3 inches Weight 170lbs
6. Nulliparous or first pregnancy after the age of 30 years
7. Age 55
8. Mother died of colon cancer
A. 1, 2, 4, 5, 6 and 8
B. 1, 2, 3, 4, 6 and 7
C. 1, 3, 5, 6 and 8
D. 1, 2, 3, 5 and 6
E. 1, 2, 3, 4, 6 and 8
74. The evening nurse goes in to care for a client who had a modified mastectomy that morning. Which fact is
essential for the nurse to know to provide safe care?
A. The involved arm should be wearing an elastic sleeve
B. The involved arm should not be used for BP measurement
C. The involved arm should be not be exercised for 10 days
D. The involved arm should be maintained at the level of the heart
76. How should the care of a client undergoing brachytherapy be assigned?
A. To male nurses whenever possible
B. On a rotating basis among non-pregnant nursing staff
C. Consistently to the same nurses
D. Never to a nurse with a history of cancer
Rationalization:
 To limit exposure to specific individuals, care of clients undergoing brachytherapy should be rotated
among staff members with the exception of those who are pregnant because of the risk of damage to
the developing fetus.
 Male gender or cancer history are not considered influencing factors.
 Assigning the same nurses would support consistency and efficiency of care but these benefits do not
outweigh the risk of exposure.
77. Which information could be correctly included in the teaching plan for a client receiving chemotherapy?
A. Scalp hair may be lost but all body hair is unaffected
B. Hair loss usually occurs 6–8 weeks after chemotherapy starts
C. Regrowth usually starts 1-2 months after chemotherapy is completed
D. Hair regrowth can be expected to take 14 days
Rationalization:
 Regrowth of hair usually starts 1–2 months after chemotherapy is completed.
 Both scalp and body hair may be lost and loss usually starts 2–3 weeks after treatment starts.
78. Which client with breast cancer is a candidate for treatment with Tamoxifen?
A. A 32-year-old client with a lumpectomy for a small tumor and no sign of spread
B. A 58-year-old client with negative estrogen receptor (ER) status
C. A 41-year-old client with metastatic disease
D. A 66-year-old client with estrogen sensitive disease
 Tamoxifen is adjuvant therapy for early stage ER—positive breast cancer.
 Tamoxifen is an estrogen antagonist that blocks the ER sites on the tumor cells thus blocking
tumor growth.
 It decreases the risk of metastasis or prolongs survival once metastasis occurs.
79. What is the priority of care in a client that is undergoing external radiation therapy?
A. Washing the markings off of the face
B. Maintaining a 6-ft distance
C. Grouping client care to minimize exposure to the radiation
D. Assessing the skin for burned areas
 The client should be assessed for areas that are burned so that treatment can occur to prevent
further damage to the skin and underlying tissues.
  Fluid volume status should also be addressed due to the body’s response to the burn.
80. A client has experienced mucositis while undergoing radiation therapy. Which nursing action will be best to
assist the client’s nutritional intake?
A. Offer the client foods with enhanced taste
B. Offering a commercially prepared mouth rinse
C. Offer the client bland, soft foods such as puddings, shake
D. Administer oral antibiotics to the client to swish daily
 The client should avoid spicy or hard foods if mucositis occurs.
 By offering the client foods that are bland and soft, he or she will be more likely to continue eating
and maintain a nutritional intake sufficient for the body’s needs.
81. A laryngeal cancer patient underwent post total laryngectomy. He has fully recovered. What functional changes
would the patient expect?
A. Difficulty swallowing and minimal loss of voice
B. Alternative airway, normal swallowing, and loss of voice
C. Loss of voice, mouth breathing and normal sense of taste
D. Sense of taste and smell intact, Alternative airway and loss of voice
 With or without neck dissection, a total laryngectomy requires a permanent tracheal stoma, because
the larynx that provides the protective sphincter is no longer present.
 The tracheal stoma prevents the aspiration of food and fluid into the lower respiratory tract.
 The patient will have no voice but will have normal swallowing.
 A total laryngectomy changes the manner in which airflow is used for breathing and speaking
82. A client with early stage laryngeal cancer in the glottis area would undergo a partial laryngectomy
(laryngofissure-thyrotomy). He asks how is this performed. The nurse would reply:
A. Hyoid bone, epiglottis, cricoid cartilage and 2-3 rings of trachea will be removed while the tongue, pharyngeal
walls and trachea are preserved
B. Thyroid cartilage is split in the midline of the neck and portion of vocal cord (one true and one false cord),
arytenoid cartilage and half of the thyroid is removed with the tumor; he will have a tracheostomy tube and
NGT for 10-14 days after surgery and is at risk of aspiration
C. Hyoid bone, glottis, and false vocal cords are removed, while true vocal cords, cricoid cartilage, and trachea
remain intact; voice will be preserved with a new method of swallowing
D. A portion of the larynx is removed, along with one vocal cord and the tumor; airway remains intact and with
no difficulty in swallowing, however, voice quality may change (hoarseness)
 A – Total laryngectomy
 B – Hemilaryngectomy
 C – Supraglottic laryngectomy (early stage I supraglottic and stage II lesions)
83. True regarding promoting adequate nutrition in patients post laryngectomy include the following EXCEPT:
A. Patient may not be permitted to eat or drink for 10 to 14 days
B. Thick liquids will be used first if allowed oral feedings because they are easy to swallow
C. Encourage sweet foods because patient may have a diminished sense of taste and smell for a
period of time after surgery
D. Rinse mouth with warm water or mouthwash and brush teeth frequently
 The nurse should instruct patient to avoid sweet foods which increase salivation and suppress
appetite
 Solid foods are introduced as tolerated

CARE OF THE PATIENTS WITH GENITO-URINARY TRACT DISORDERS

84. A 35-year-old woman presents to the clinic with a 2-day history of painful burning urination (dysuria), frequency,
and urgency. She does not have any discharge or pain during intercourse (dyspareunia). Physical exam is
significant for suprapubic tenderness. There is no CVA tenderness. She has been in a monogamous relationship
with her husband for the last 10 years. Vital signs are normal. What is the most likely diagnosis for this patient
based on the manifestations?
A. Cholecystitis
B. Cystitis
C. Glomerulonephritis
D. Acute Kidney Failure
85. Which of the following is an iatrogenic risk factor for UTI?
A. Sex
B. Diabetes
C. Immobility due to injury
D. Frequent catheter insertions
86. Dysuria is a very distressing symptom of UTI. To manage this symptom the patient may be given:
A. Trimethroprim
 B. Sulfamethoxazole
C. Phenazopyridine
D. Fluoroquinolone
87. The nurse is caring for a patient following prostate surgery. Upon assessment, the nurse notes that the patient
has a urinary catheter that is secured very snugly to the inner thigh. The nurse understands that the catheter:
A. Is positioned to help prevent hemorrhage
B. May be repositioned if the patient is uncomfortable
C. Should be repositioned at least every few hours
D. Will normally drain urine with large clots
Venous blood appears darker and less viscous. Arterial hemorrhage usually requires surgical
intervention
(eg, suturing or transurethral coagulation of bleeding vessels), whereas venous bleeding may be
controlled by applying prescribed traction to the catheter so that the balloon holding the catheter in
place applies pressure to the
prostatic fossa. The surgeon applies traction by securely taping the catheter to the patient’s thigh if
hemorrhage occurs. P. 1528 Brunner 12th ed.
88. The nurse is caring for a patient following prostate surgery who has an indwelling
catheter. The patient informs the nurse that he feels like he needs to void. Which of the following is the best
response by the nurse?
A. Inform the patient that the feeling is normal, but discourage straining to try to void
B. Tell the patient that he can try to void if it will make him feel more comfortable
C. Encourage the patient to go ahead and try to void because it may help to pass a clot
D. Notify the surgeon immediately because this is a sign of impending hemorrhage
While the prostatic fossa heals (6 to 8 weeks), the patient should avoid activities that produce Valsalva
effects
(straining, heavy lifting) because this may increase venous pressure and produce hematuria. Page
1530
89. The nurse is providing care for a patient with continuous bladder irrigation (CBI) following removal of the
prostate. The nurse understands that the CBI should be adjusted as needed to result in catheter outflow of
which of the following types?
A. Cloudy yellow
B. Light pink
C. Amber with clots
D. Cherry colored with clots
90. The nurse is providing care for a patient with benign prostatic hypertrophy. Clinical
manifestations, as described by the patient, include:
A. Urinary frequency with strong stream
B. Difficulty starting and stopping the stream
C. Daytime urinary frequency with incontinence
D. Fever, chills, nausea, and vomiting
91. Which assessment finding(s) on a client who had a transurethral resection of the prostate for BPH 4 hours ago
would indicate the need to notify the physician?
A. Red bloody urine with small clots
B. BP of 100/50 mmHg, pulse 130 bpm
C. Urinary output of 200 ml greater than intake
D. Pain related to bladder spasms
 A rapid pulse with a low BP is a potential sign of excessive blood loss and physician should be
notified based on this finding.
 Some hematuria is usual for several days after surgery.
 A urinary output of 200 ml or greater than intake is adequate.
 Bladder spasms are expected to occur following surgery.
92. Which is the primary factor that determines the time interval that can elapse between removal of an organ from
a donor and its transplantation into a recipient?
A. Time an organ can survive ischemia
B. Ability of the organ to withstand temperature change
C. Amount of DNA present in the organ’s cells
D. Number of bacteria in the blood
 Oxygen, which is essential to cell survival, is brought to the tissues by the blood.
 Once an organ is removed from the donor its cells no longer have a source of oxygenated blood
until it is implanted in the recipient.
 Different types of cells/tissues can withstand ischemia for different lengths of time. Hence, how
long the organ can survive until implanted depends on this ability of the cells to withstand ischemia.
93. An unidentified client is brought to the emergency department after being found on the side of the road with
multiple stab wounds and an obvious head injury. After a series of radiological test, it is found that the client
 has a lacerated kidneys, brain injury, and needs immediate surgery. Which of the following would be best in
obtaining consent for the surgical procedure?
A. The client should be placed in police custody and consent obtained from the appropriate personnel
B. The physician should consider this implied consent and should follow the hospital policy for the
situation
C. The nurse should sign consent for the client as the client advocate
D. The facility should wait to see if the client wakes up to give consent
 The hospital policy should be followed in this situation. In implied consent, the law recognizes that
client in need of life saving measures will be provided with those measures unless documents can
be provided that states otherwise.
 In this situation, the client is unidentified and needs surgery to save his life.

CARE OF THE PATIENTS WITH NEUROLOGICAL PROBLEMS

94. A client was brought to the ER with suspected head injury. The physician asked you to assess the client’s
Glasgow Coma Scale. Which is not included in GCS?
A. Eye opening
B. Verbal response
C. Motor response
D. Pupil dilation
95. A patient with head trauma may suffer alterations in temperature due to possible damage to the hypothalamus.
Why is it necessary to maintain normal temperature in a patient with head injury?
A. Temperature elevation increase metabolic demand
B. Temperature alterations provides additional stress to the body
C. Temperature changes can increase ICP
D. To prevent cerebral ischemia

96. What is indicated by a Glasgow Coma scale score of 3?

A. Coma
B. Lethargy
C. Obtunded consciousness
D. Alert status
97. The nurse is caring for the client with increased intracranial pressure. The nurse would note which of the
following trends in vital signs if the intracranial pressure is rising?
A. Increased Temp, increased PR, increased RR, decreased BP
B. Increased Temp, decreased PR, decreased RR, increased BP
C. Decreased Temp, decreased PR, increased RR, decreased BP
D. Decreased Temp, increased PR, decreased RR, increased BP

CARE OF THE PATIENTS WITH EYE PROBLEMS

98. Initially after the CVA, a client’s pupil’s are equal and reactive to light. Later the nurse assesses that the right
pupil is reacting more slowly than the left and systolic blood pressure is beginning to rise. The nurse recognizes
that these adaptations are suggestive of:
A. Spinal shock
B. Hypovolemic Shock
C. Brain herniation
D. Increasing intracranial pressure
99. A client having surgery for glaucoma asks the nurse how the doctor will know if the surgery is successful. Which
would be an appropriate response for the nurse to make?
A. IOP will decrease
B. Ability to read small print will improve
C. Pupil will remain permanently dilated
D. Peripheral vision will increase
100. 100. The major objective of ocular medication delivery is to maximize the amount of medication that reaches
the ocular site of action in sufficient concentration to produce a beneficial therapeutic effect. Which among the
following medications commonly best exemplifies this objective?
A. Ophthalmic drops
B. Ophthalmic ointment
C. Subconjunctival injection
D. Contact lenses with antibiotics
 Ophthalmic ointments have extended retention time in the conjunctival sac and a higher
concentration than eye drops.
 Although eye drops are the most common, corneal contact time is brief because tears dilute the
medication.
 Subconjunctival injection and contact lenses with antibiotics are only used in few severe cases.