Name: __________________________ Date: _____________

1. A patient has just been diagnosed with cancer and states that he will
“never be able to cope with this situation.” The nurse is aware that
coping is:
A) A physiologic measure used to deal with change and he will
physically adapt
B) The physiologic and psychological processes that people use to
adapt to change
C) The human need for faith and hope, which create change
D) A social measure used to deal with change and loss

2. The nurse is with a patient who has just been informed of his terminal
illness. His heart rate increases, his eyes dilate, and his blood
pressure increases. The nurse recognizes this response as a:
A) Part of the limbic system C) Hypothalamic-pituitary
response response
B) Sympathetic nervous D) Local adaptation syndrome
response

3. The nurse at the student health center is seeing a nursing student

who is interested in reducing his stress level. The nurse identifies
guided imagery as an appropriate intervention. Guided imagery
involves:
A) The use of progressive tensing and relaxing of muscles to release
tension in each muscle group
B) Using positive self-image to increase and intensify physical
workouts in the gym, which decreases stress
C) The mindful use of a word, phrase, or visual image that allows
one's self to be distracted and temporarily escape from stressful
situations
D) The use of music and humor to create a calm and relaxed
demeanor, which allows escape from stressful situations

4. A nurse is meeting with a young woman who has recently lost her
mother, her job, and moved with her husband to a new city. She is
complaining of acute anxiety and depression. The nurse knows:
A) Adaptation often fails during stressful events and results in
homeostasis.
B) Stress is a part of our lives and eventually this young woman will
adapt.
C) Acute anxiety and depression are seldom associated with stress.
D) Sometimes too many stressors disrupt homeostasis; if adaptation
fails, the result is disease.

5. A 72-year-old female is recovering from abdominal surgery on the

medical-surgical unit. The surgery was very stressful and prolonged;
the nurse notes on the chart that her blood sugars are elevated yet
she has not been diagnosed with diabetes. The nurse realizes:
A) It is a result of antidiuretic hormone.
B) She must have had diabetes prior to surgery.
C) She has become a diabetic from the abdominal surgery.
D) The blood sugars are probably a result of the “fight or flight”
reaction.

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 6. A patient has come to the health center with an enlarged thyroid; the
nurse practitioner believes the thyroid cells may suffer from
hyperplasia and is aware that:
A) Hyperplasia is an abnormal decrease in cell and organ size and is
a precursor to cancer.
B) Hyperplasia is an abnormal increase in new cells and is reversible
with the stimulus for cell growth removed.
C) Hyperplasia is the change in appearance due to a chronic
irritation and will reverse with the stimulus removed.
D) Hyperplasia is a cancerous growth and will be removal surgically.

7. A 10-year-old boy and his mother are being seen in the emergency
department (ED) by the triage nurse. The boy was stung by a bee
about an hour ago, and the mother tells the nurse that it is very
painful, looks swollen, red, and infected. The nurse teaches the
mother that:
A) The pain, redness, and swelling are part of the inflammatory
process but it is probably too early for an infection.
B) Bee stings frequently cause infection, pain, and swelling and,
with treatment, the infection should begin to subside late today.
C) The infection was probably caused by the stinger which may still
be in the wound.
D) The mother's assessment is excellent and the ED doctor will
probably prescribe antibiotics to fix the problem.

8. An older female patient is being treated for acute anxiety and has a
nursing diagnosis of ineffective coping patterns related to feelings of
helplessness. The most appropriate nursing intervention would be:
A) Provide the patient with realistic choices for her care.
B) Assess and provide constructive outlets for anger and hostility.
C) Assess the patient's need for social support.
D) Encourage an attitude of realistic hope to help deal with helpless
feelings.

9. A 35-year-old woman comes to the local health center with a large

mass is her right breast. She has felt the lump for about a year but
was afraid to come to the clinic because she was sure it was cancer.
The most appropriate nursing diagnosis would be:
A) Self-esteem disturbance C) Altered family process
B) Ineffective individual coping D) Ineffective denial

10. Chronic stress is a problem in today's society and it requires the

attention and teaching of nurses. Which of the following stressors
causes the greatest impact on health?
A) Day-to-day hassles B) Technologic change C) Divorce D)
Retirement

11. Your patient is a 45-year-old man with a type A personality who has
been admitted with hypertension. You know that potentially this
patient is at an increased risk for:
A) Myocardial infarction B) Liver failure C) Lung disease D)
Depression

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12. The nurse informs the patient who is a heavy smoker and may have
dysplasia of epithelial cells in the bronchi that:
A) This is harmless, as lung tissue regenerates.
B) Dysplastic cells may become malignant.
C) Surgery is often required for this condition.
D) Dysplasia may cause scar tissue.

13. A patient who has been admitted after near drowning was submerged
for 10 minutes and remains unconscious. What possible damage to
the body has occurred as a result of the submersion?
A) Atrophy to brain cells C) Hypoxia to the brain
B) Cellular injury D) Necrosis to the brain

14. A patient who is a construction worker has a chemical injury on his

arm caused by lye. What assessment should the nurse make to the
arm?
A) Damage to the epithelial C) Joint immobility
tissues
B) Pigment changes D) Muscle tonicity

15. The patient has a temperature of 106° F. The nurse should be aware
that the oxygen demands of the body would:
A) Increase due to an increase in metabolism
B) Decrease due to a decrease in metabolism
C) Increase due to a decrease in metabolism
D) Decrease due to an increase in metabolism

16. The nurse is caring for a patient who has an ankle with acute
inflammation. Which of the following statements is true regarding
acute inflammation?
A) It is the same as infection.
B) It may impair the healing process.
C) It is a defensive reaction intended to remove an offending agent.
D) It inhibits the release of histamines in the tissues.

17. The patient has been complaining of tightness in the shoulder muscle
and frequent headaches. Which of the following might the nurse
implement in patient teaching?
A) Teach the patient to tense and relax the muscle groups.
B) Encourage the patient to express his or her feelings.
C) Encourage the patient to seek peer support.
D) Explain the use of analgesics for discomfort.

18. The nurse in a clinic is seeing a child with leukemia. The parents are
having trouble coping and ask the nurse for advice. What is the
nurse's best response?
A) Suggest a support group for parents of children with leukemia.
B) Have the parents see a social worker.
C) Encourage the parents to have hope.
D) Offer a website to gain information.

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19. A nurse is preparing to administer a first dose of meperidine for a
postoperative patient. Prior to administering the drug, the nurse
should assess for which of the following?
A) The patient's electrolyte values
B) The patient's blood pressure
C) The patient's allergies to any medications
D) The patient's hydration status

20. A patient is receiving postoperative analgesia through a PCA pump.

The nurse has given the patient a bolus of a narcotic medication. It is
important for the nurse to assess the patient for:
A) Sedation C) Fluid overload
B) Respiratory depression D) Changes in their skin
integrity

21. A palliative patient being assessed in a pain clinic indicates that pain
control has been poor. He has been saving his analgesics until the
pain is intense. What teaching should be done with this patient?
A) Medication should be taken when pain levels are low so the pain
is easier to reduce.
B) Pain medication can be increased when the pain is intense.
C) It is difficult to control chronic pain, so little can be done.
D) Instruct the patient to lie still and think of something else during
intense pain.

22. When administering an analgesic to an elderly patient for pain, what

interventions should the nurse implement in the plan of care for the
patient?
A) Monitor for signs of drug toxicity due to a decrease in
metabolism.
B) Monitor for an increase in absorption of the drug due to
increased metabolism.
C) Monitor for an increase in respiratory rates.
D) Analgesics should be given every 4 to 6 hours as ordered to
control pain.

23. The nurse is assessing a patient's pain using the pain scale. The
patient is tearful, hesitant to move, and grimacing. The patient rates
the pain at this time as a 2 using the pain scale. The nurse should
conclude which of the following?
A) The patient has rated the pain as minimal according to the scale.
B) The nurse should reinforce teaching about the pain scale number
system.
C) The nurse should reassess the pain in 30 minutes.
D) The medication the patient is receiving is not adequate for pain
relief.

24. The nurse is caring for a patient with chronic fatigue and back pain
that is not well controlled. What should the nurse assess for other
than pain in this patient?
A) Potential contractures C) Depression
B) The need for a placebo D) Sleep pattern disturbances

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25. A patient with chronic pain informs the nurse that he will not take
codeine because it makes him constipated. What teaching should be
done with this patient?
A) Discuss another form of pain control.
B) Constipation will lessen with regular use of codeine.
C) Use a stool softener with the codeine to prevent constipation.
D) Stool regularity should not replace adequate pain control.

26. A nurse is caring for a 74-year-old patient with chronic pain who is
prescribed an opioid medication for pain relief. The nurse should
explain to the patient that for elderly patients:
A) Meperidine is usually the drug of choice.
B) Intervals between doses are the same as for younger patients.
C) Absorption and metabolism of medications may be higher.
D) Smaller doses of medication are required for pain relief.

27. A patient is receiving massage for chronic back pain. The nurse
should explain to the patient that the massage therapy provides
comfort by:
A) Stimulating the non-pain receptors
B) Providing distraction from the pain
C) Helping to reduce inflammation in the tissues
D) Producing muscle relaxation

28. The nurse is caring for a patient receiving patient-controlled analgesia

(PCA) for pain management. Which statement about PCA is true?
A) The PCA pump can't infuse narcotics continuously.
B) Pain relief is initiated by the patient as needed.
C) No complications related to narcotic delivery by the pump exist.
D) The nurse prescribes the dosage of narcotic for delivery.

29. A patient is prescribed transcutaneous electrical nerve stimulation

(TENS) for pain relief. The rationale for using TENS is to:
A) Help relax tense muscles
B) Prevent stiffness and further loss of mobility
C) Reduce swelling and inflammation
D) Block painful stimuli traveling over small nerve fibers

30. The nurse is providing preoperative care to a patient scheduled for an

appendectomy. Which statement regarding pain control is most
appropriate?
A) "There's no need to ask for pain medication, you'll receive it on a
schedule."
B) "Take your pain medication after walking so that you won't feel
dizzy."
C) "Take your pain medication before your pain becomes intense."
D) "Use as little pain medication as possible to avoid addiction."

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31. A 52-year-old female patient is seeing the nurse on the oncology unit
for pain control related to breast cancer that has metastasized to her
lungs and liver. The nurse wants to prevent further pain and is aware
that:
A) Cancer pain is often related to the stress of the patient knowing
they have cancer and requires a very low dose of pain
medications along with a high dose of anti-anxiety medications.
B) Cancer pain is always chronic and difficult to treat so distraction
is often the best intervention.
C) Cancer pain can be acute or chronic and may even be the result
of the cancer treatment and usually requires high doses of pain
medications.
D) Cancer patients often misreport pain because of confusion
related to their disease process.

32. A 35-year-old man who is having problems at work is seeing the nurse
at a primary care clinic for chronic low back pain. In the past year, he
has been absent from work about once every two weeks, is short-
tempered with other workers, feels tired all the time, and is worried
about losing his job. The goals for the plan of care should focus on:
A) Increasing pain tolerance and exercise
B) Decrease the need to work and increase sleep to eight hours per
night
C) Evaluate other work options to decrease the risk of depression
D) Decrease the time lost from work, to increase the quality of
interpersonal relationships and decrease anxiety

33. A 60-year-old man with diabetes has a below-knee amputation and

asks, “Why does it still feel like my leg is attached and in pain?” The
nurse explains that our minds gather information and develop
patterns called a neurosignature, all the parts of our bodies become a
part of the pattern, and it takes time for the pattern to adapt to
change or loss. This pattern is a part of the:
A) Personal pattern analysis C) Anxiety control measures
B) Past experience D) Extended gate control theory

34. A 47-year-old woman is coming to the medical-surgical floor from the

emergency department for observation of a severely broken leg. The
medical-surgical nurse reviews her PRN medications and sees that
she has an NSAID (ibuprofen) ordered every 4 hours. If she wanted to
implement preventative pain measures when the patient arrives, the
nurse would:
A) Check for allergies, use a pain scale to assess the patient's pain,
and let the patient know ibuprofen is available every 4 hours if
she needs it.
B) Do a complete assessment and give pain medication based on
the patient's report of pain.
C) Check for allergies, use a pain scale to assess the patient's pain
and offer the ibuprofen every 4 hours until the patient is
discharged.
D) Provide medication as per patient request and offer relaxation
techniques to promote comfort.

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35. A 74-year-old man who has just returned to the medical-surgical floor
following surgery for a total knee replacement says he has “been
confused in the past” when he takes pain medications. The nurse
realizes that the elderly may:
A) Require lower doses of medication and are easily confused with
new medications
B) Have altered absorption and metabolism, which prohibits the use
of opiates
C) Be confused following surgery and that is related to normal aging
and unrelated to the medication
D) Require a higher initial dose of pain medication followed by a
tapered dose

36. The mother of a cancer patient comes to the nurse concerned with
her daughter's safety; the morphine dose she needs to control her
pain is getting “higher and higher.” The mother is afraid that her
daughter will overdose. The nurse educates the mother to the fact
that:
A) The dose range is higher with cancer patients and we will be very
careful to prevent addiction.
B) Frequently, women need higher doses of morphine to be
comfortable.
C) Cancer is a terminal illness that requires higher doses of
narcotics.
D) There is no maximum opioid dose and your daughter is just
becoming more tolerant to the drug.

37. The home health nurse has delivered a patient-controlled analgesia

(PCA) pump to a homebound client who is terminally ill. The family
members will be taking care of the patient. The priority nursing
interventions are to:
A) Teach the family the theory of pain management and the use of
alternative therapies.
B) Provide family support during this emotional experience.
C) Teach the patient and family the operation of the pump,
monitoring of the IV site, and the side effects of the medication.
D) Teach the family how to use morphine and recognize morphine
overdose, and offer spiritual guidance.

38. An 88-year-old man is suffering from long-term severe intractable

pain; all pharmacologic and nonpharmacologic methods of pain relief
have been ineffective. The nurse tells the patient that he may want to
consider:
A) Investigating new alternative pain management options that are
outside the United States
B) Consulting a neurologist or neurosurgeon to discuss pain
management options
C) Significantly increasing his exercise and activities to create
distractions
D) Moving into a nursing home, so others may care for him

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39. The home health nurse developing a plan of care for a patient who
will be managing his chronic pain at home should focus the teaching
on the concepts of:
A) Self-care and safety C) Health promotion and
exercise
B) Autonomy and need D) Dependence and health

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